Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, School of Medicine, Johns Hopkins University, 733 North Broadway, Suite 101, Baltimore, MD, 21205, USA.
World J Surg. 2020 Sep;44(9):3130-3140. doi: 10.1007/s00268-020-05560-9.
Prior randomized trials showed comparable short-term outcomes between open and minimally invasive proctectomy (MIP) for rectal cancer. We hypothesize that short-term outcomes for MIP have improved as surgeons have become more experienced with this technique.
Rectal cancer patients who underwent elective abdominoperineal resection (APR) or low anterior resection (LAR) were included from the American College of Surgeons National Surgical Quality Improvement Program database (2016-2018). Patients were stratified based on intent-to-treat protocol: open (O-APR/LAR), laparoscopic (L-APR/LAR), robotic (R-APR/LAR), and hybrid (H-APR/LAR). Multivariable logistic regression analysis was used to assess the impact of operative approach on 30-day morbidity.
A total of 4471 procedures were performed (43.41% APR and 36.59% LAR); O-APR 42.72%, L-APR 20.99%, R-APR 16.79%, and H-APR 19.51%; O-LAR 31.48%, L-LAR 26.34%, R-LAR 17.48%, and H-LAR 24.69%. Robotic APR and LAR were associated with shortest length of stay and significantly lower conversion rate. After adjusting for other factors, lap, robotic and hybrid APR and LAR were associated with decreased risk of overall morbidity when compared to open approach. R-APR and H-APR were associated with decreased risk of serious morbidity. No difference in the risk of serious morbidity was observed between the four LAR groups.
Appropriate selection of patients for MIP can result in better short-term outcomes, and consideration for MIP surgery should be made.
先前的随机试验表明，开放和微创直肠切除术（MIP）治疗直肠癌的短期结果相当。我们假设，随着外科医生对该技术的经验越来越丰富，MIP 的短期结果已经得到改善。
从美国外科医师学会国家手术质量改进计划数据库（2016-2018 年）中纳入接受选择性腹会阴切除术（APR）或低位前切除术（LAR）的直肠癌患者。根据意向治疗方案对患者进行分层：开放（O-APR/LAR）、腹腔镜（L-APR/LAR）、机器人（R-APR/LAR）和杂交（H-APR/LAR）。采用多变量逻辑回归分析评估手术方法对 30 天发病率的影响。
共完成 4471 例手术（43.41% APR 和 36.59% LAR）；O-APR 42.72%，L-APR 20.99%，R-APR 16.79%，H-APR 19.51%；O-LAR 31.48%，L-LAR 26.34%，R-LAR 17.48%，H-LAR 24.69%。机器人 APR 和 LAR 与最短的住院时间和显著较低的转化率相关。在调整其他因素后，与开放方法相比，腹腔镜、机器人和杂交 APR 和 LAR 与整体发病率降低相关。R-APR 和 H-APR 与严重发病率降低相关。在四种 LAR 组之间，严重发病率的风险没有差异。
适当选择 MIP 患者可以获得更好的短期结果，应考虑进行 MIP 手术。
