Chen Yi-Ting, Huang Ching-Wen, Ma Cheng-Jen, Tsai Hsiang-Lin, Yeh Yung-Sung, Su Wei-Chih, Chai Chee-Yin, Wang Jaw-Yuan
Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
BMC Surg. 2020 Feb 3;20(1):23. doi: 10.1186/s12893-020-0687-1.
Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation.
This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months.
Upon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS.
This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.
全直肠系膜切除术（TME）联合或不联合新辅助同步放化疗（CCRT）是直肠癌（RC）的治疗方法。近年来，传统腹腔镜手术（LS）或机器人辅助手术（RS）的应用病例一直在稳步增加。然而，不同手术方式的各种肿瘤学结局仍在研究中。
这是一项回顾性观察研究，纳入了300例在单一中心接受各种TME技术（RS，n = 88；LS，n = 37；开放手术，n = 175）的连续RC患者，以比较病理和肿瘤学结局，中位随访时间为48个月。
多因素分析显示，组织学分级（P = 0.016）和分期（P < 0.001）是环周切缘（CRM）受累的独立因素。Kaplan-Meier生存分析确定，RS、早期病理分期、CRM阴性受累和病理完全缓解与更好的总生存（OS）和无病生存（DFS）显著相关（所有P < 0.05）。多变量分析观察到手术方式（P = 0.037）、组织学分级（P = 0.006）和CRM受累（P = 0.043）是DFS的独立因素，而组织学分级（P = 0.011）和病理分期（P = 0.022）是OS的独立预后变量。
本研究确定RS TME是可行的，因为它比其他手术方式的CRM受累更少，肿瘤学结局更好。影响CRM和预后的重要因素取决于组织学分级、肿瘤深度和术前CCRT。由于RS对接受TME的RC患者具有良好的肿瘤学结局，可能是一个可接受的选择。
