Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, Florida.
Ann Surg. 2021 Dec 1;274(6):e1218-e1222. doi: 10.1097/SLA.0000000000003805.
To compare short term outcomes of patients undergoing laparoscopic or robotic rectal cancer surgery.
Significant benefits of robotic rectal cancer surgery over laparoscopy have yet to be demonstrated. Operative time and direct institutional cost seem in favor of the laparoscopic approach.
We performed a retrospective review of consecutive patients operated on for rectal cancer with a mini-invasive approach at Mayo Clinic from 2005 to 2018. The primary aim of this study was to investigate the difference in postoperative morbidity between the laparoscopic and robotic approach. Multivariable models for odds to complications and prolonged (≥6 days) length of stay were built.
A total of 600 patients were included in the analysis. The number of patients undergoing robotic surgery was 317 (52.8%). The 2 groups were similar in respect to age, sex, and body mass index. Laparoscopic surgery was correlated to shorter operative time (214 vs 324 minutes; P < 0.001). Patients undergoing robotic surgery had a lower overall complications rate (37.2% vs 51.2%; P < 0.001). Robotic surgery was found to be the most protective factor [odds ratio (OR) 0.485; P = 0.006] for odds to complications. The event of a complication (OR 9.33; P < 0.001) and conversion to open surgery (OR 3.095; P = 0.002) were identified as risk factors for prolonged length of stay whereas robotic surgery (OR 0.62; P = 0.027) was the only independent protective factor.
Robotic rectal cancer surgery is strongly associated with better short-term outcomes over laparoscopic surgery.
比较腹腔镜和机器人直肠肿瘤手术患者的短期预后。
机器人直肠肿瘤手术相较于腹腔镜具有显著优势，但目前尚未得到证实。手术时间和直接机构成本似乎更倾向于腹腔镜方法。
我们对梅奥诊所 2005 年至 2018 年间接受微创直肠肿瘤手术的连续患者进行了回顾性研究。本研究的主要目的是探讨腹腔镜和机器人方法之间术后发病率的差异。建立了并发症和延长（≥6 天）住院时间的多变量模型。
共纳入 600 例患者进行分析。317 例（52.8%）患者接受机器人手术。两组在年龄、性别和体重指数方面相似。腹腔镜手术与较短的手术时间相关（214 分钟 vs 324 分钟；P<0.001）。机器人手术患者的总并发症发生率较低（37.2% vs 51.2%；P<0.001）。机器人手术是并发症发生率的最保护因素（比值比 0.485；P=0.006）。并发症的发生（比值比 9.33；P<0.001）和转为开放性手术（比值比 3.095；P=0.002）是延长住院时间的危险因素，而机器人手术（比值比 0.62；P=0.027）是唯一的独立保护因素。
机器人直肠肿瘤手术与腹腔镜手术相比，具有更好的短期预后。
