Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Department of Surgery, City of Hope National Medical Center, Medical Office Bldg., 1500 East Duarte Road, Duarte, CA, 91010, USA.
Surg Endosc. 2020 Nov;34(11):4932-4942. doi: 10.1007/s00464-019-07284-x. Epub 2019 Dec 9.
Minimally invasive surgery (MIS) continues to gain traction as a feasible approach for the operative management of gastrointestinal (GI) malignancies. The aim of this study is to quantify national trends, perioperative and oncologic outcomes of MIS for the most common GI malignancies including the esophagus, stomach, pancreas, colon, and rectum. We hypothesize that with more widespread use of MIS techniques, perioperative outcomes and oncologic resection quality will remain preserved.
The National Cancer Database (2010-2014) was utilized to assess perioperative outcomes and pathologic quality of MIS (robotic and laparoscopic) compared to open, in patients who underwent resection for cancers of the esophagus, stomach, pancreas, colon, and rectum. Multilevel logistic regression models were constructed to identify independent factors associated with postoperative and long-term outcomes.
Data from 11,023 esophageal, 30,664 gastric, 30,689 pancreas, 260,669 colon, and 52,239 rectal resections were analyzed. Although laparoscopy is the most prevalent MIS approach, the number of robotic resections increased nearly fourfold from 2010 to 2014 in all organ sites (increase by factor: esophagus: 3.8, stomach: 4.4, pancreas: 4.4, colon: 3.8 and rectum: 4). The number of laparoscopic resections increased at a slower rate (factor: 1.3-1.9), whereas the number of open resections decreased (factor: 0.67-0.77). Patients who underwent robotic-assisted resections were younger for stomach and colorectal resections and with lower Charlson Comorbidity Index across all sites. Patients who underwent robotic or laparoscopic resections had shorter hospitalizations, fewer readmissions (with the exception of rectal resections) and lower postoperative mortality at 90 days. Robotic-assisted resections had comparable negative margin resections and number of lymph nodes to laparoscopic and open resections across all sites.
The utilization of robotic-assisted resections of GI cancers is rapidly increasing with more frequent use in younger and healthier patients. This study demonstrates that with the rising utilization of robotic-assisted resections, perioperative outcomes and oncologic safety have not been compromised.
微创外科（MIS）作为胃肠道（GI）恶性肿瘤的一种可行的手术治疗方法，其应用持续增加。本研究的目的是量化最常见的 GI 恶性肿瘤（包括食管、胃、胰腺、结肠和直肠）的 MIS 的全国趋势、围手术期和肿瘤学结果。我们假设，随着 MIS 技术的广泛应用，围手术期结果和肿瘤切除质量将保持不变。
利用国家癌症数据库（2010-2014 年）评估了接受食管、胃、胰腺、结肠和直肠癌症切除术的患者中，与开放手术相比，MIS（机器人和腹腔镜）的围手术期结果和病理质量。建立多水平逻辑回归模型，以确定与术后和长期结果相关的独立因素。
共分析了 11023 例食管、30664 例胃、30689 例胰腺、260669 例结肠和 52239 例直肠切除术的数据。虽然腹腔镜是最常见的 MIS 方法，但在所有器官部位，机器人切除术的数量从 2010 年到 2014 年几乎增加了四倍（食管：增加 3.8 倍；胃：增加 4.4 倍；胰腺：增加 4.4 倍；结肠：增加 3.8 倍；直肠：增加 4 倍）。腹腔镜切除术的数量增加速度较慢（因素：1.3-1.9），而开放切除术的数量减少（因素：0.67-0.77）。接受机器人辅助切除术的患者在胃和结直肠切除术方面年龄较小，并且在所有部位的 Charlson 合并症指数都较低。接受机器人或腹腔镜切除术的患者住院时间更短，再入院率（直肠切除术除外）较低，术后 90 天死亡率较低。在所有部位，机器人辅助切除术与腹腔镜和开放切除术相比，具有相似的阴性边缘切除术和淋巴结数量。
机器人辅助 GI 癌症切除术的应用正在迅速增加，并且在更年轻和更健康的患者中更频繁地使用。本研究表明，随着机器人辅助切除术的应用增加，围手术期结果和肿瘤安全性并未受到影响。
