Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Br J Surg. 2020 Apr;107(5):560-566. doi: 10.1002/bjs.11435. Epub 2020 Jan 24.
The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery.
A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m or more) was performed.
A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non-obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71).
Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non-obese patients.
本研究旨在回顾接受微创腹部手术的直肠癌患者队列中转手术的风险因素。
对 2005 年 2 月至 2018 年 4 月连续接受手术的患者进行了回顾性分析。纳入接受微创入路治疗原发性直肠腺癌的低位前切除术或腹会阴切除术的成年患者。排除标准为缺乏研究授权、IV 期或复发性直肠癌和急诊手术。使用逻辑回归分析转手术的风险因素。对肥胖患者（BMI 30kg/m 或更高）进行了亚组分析。
共纳入 600 例患者进行分析。总体中转手术率为 9.2%。多变量分析显示，当患者接受机器人手术时，中转手术的风险降低了 72%（比值比 (OR) 0.28，95%置信区间 0.15 至 0.52）。肥胖患者的中转手术风险比非肥胖患者高 3 倍（分别为 47%和 24.4%；P<0.001）。机器人手术与肥胖患者中转手术风险降低相关（OR 0.22，0.07 至 0.71）。
在接受微创直肠癌手术的肥胖和非肥胖患者中，机器人手术与中转手术风险降低相关。
