Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
Faculty of Sciences, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.
Int J Colorectal Dis. 2019 Dec;34(12):2081-2089. doi: 10.1007/s00384-019-03417-9. Epub 2019 Nov 11.
Robotic surgery can overcome some limitations of laparoscopic total mesorectal excision (L-TME), improving the quality of the surgery. We aim to compare the medium-term oncological outcomes of L-TME vs. robotic total mesorectal excision (R-TME) for rectal cancer.
A retrospective analysis was performed including patients who underwent L-TME or R-TME between 2011 and 2017. Patients presenting with metastatic disease or R1 resection were excluded. From a total of 680 patients, 136 cases of R-TME were matched based on age, gender, stage and time of follow-up with an equal number of patients who underwent L-TME. We compared 3-year disease-free survival (DFS) and overall survival (OS).
Major complications were lower in the robotic group (13.2% vs. 22.8%, p = 0.04), highlighting the anastomotic leakage rate (7.4% vs. 16.9%, p = 0.01). The 3-year DFS rate for all stages was 69% for L-TME and 84% for R-TME (p = 0.02). For disease stage III, the 3-year DFS was significantly higher in the R-TME group. OS was also significantly superior in the robotic group for every stage, reaching 86% in stage III. In the multivariate analysis, R-TME was a significant positive prognostic factor for distant metastasis (OR 0.2 95% CI 0.1, 0.6, p = 0.001) and OS (OR 0.2 95% CI 0.07, 0.4, p = 0.000). Moreover, major complications were also found to have a negative impact on OS (OR 8.3 95% CI 3.2, 21.6, p = 0.000).
R-TME for rectal cancer can achieve better oncological outcomes compared with L-TME, especially in stage III rectal cancers. However, a longer follow-up period is needed to confirm these findings.
机器人手术可以克服腹腔镜全直肠系膜切除术（L-TME）的一些局限性，提高手术质量。我们旨在比较直肠癌的 L-TME 与机器人全直肠系膜切除术（R-TME）的中期肿瘤学结果。
对 2011 年至 2017 年间接受 L-TME 或 R-TME 的患者进行回顾性分析。排除患有转移性疾病或 R1 切除的患者。在总共 680 名患者中，根据年龄、性别、分期和随访时间，有 136 例 R-TME 患者与接受 L-TME 的患者匹配。我们比较了 3 年无病生存率（DFS）和总生存率（OS）。
机器人组的主要并发症发生率较低（13.2% vs. 22.8%，p=0.04），突出了吻合口漏的发生率（7.4% vs. 16.9%，p=0.01）。所有分期的 3 年 DFS 率为 L-TME 组为 69%，R-TME 组为 84%（p=0.02）。对于疾病分期 III，R-TME 组的 3 年 DFS 显著更高。对于每个分期，机器人组的 OS 也显著更高，在疾病分期 III 时达到 86%。在多变量分析中，R-TME 是远处转移的显著正预后因素（OR 0.295%CI 0.1，0.6，p=0.001）和 OS（OR 0.295%CI 0.07，0.4，p=0.000）。此外，主要并发症也被发现对 OS 有负面影响（OR 8.395%CI 3.2，21.6，p=0.000）。
与 L-TME 相比，直肠癌的 R-TME 可以获得更好的肿瘤学结果，尤其是在疾病分期 III 期直肠癌中。然而，需要更长的随访时间来证实这些发现。
