Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
World J Surg. 2020 Nov;44(11):3923-3935. doi: 10.1007/s00268-020-05666-0.
The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (R-PME) versus laparoscopic (L-PME) PME for high RC.
This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum (>10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019.
Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PME patients, except for operative time (220 min and 190 min, respectively; p < 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME.
Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon's experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC.
机器人手术在高位直肠癌（RC）患者中的部分直肠系膜切除术（PME）的作用仍未得到探索。本研究旨在比较机器人（R-PME）与腹腔镜（L-PME）在高位 RC 中的 PME 手术的操作和术后结果。
这是一项单中心倾向评分队列研究，连续纳入 2012 年 9 月至 2019 年 5 月期间诊断为高位 RC（距肛门缘>10-15cm）并接受手术的患者。
在 131 名入选患者中（50 名 R-PME 和 81 名 L-PME），通过倾向评分匹配了 88 名患者（每组 44 名）。R-PME 和 L-PME 患者的手术和术后变量相似，除了手术时间（分别为 220min 和 190min；p<0.0001）。没有需要转换。总发病率为 15.9%；4 名患者（4.5%）发生吻合口漏。R-PME 的平均住院时间为 7.25 天，L-PME 为 7.64 天（p=0.597）。R-PME 组 100%达到 R0 切除，L-PME 组为 90.9%（p=0.116）。仅 3 名患者（1 名 R-PME，2 名 L-PME）接受永久性造口术（p=1）。两组在 5 年的总生存率和无病生存率方面无差异。R-PME 的成本明显高于 L-PME。
微创外科手术可以安全地进行高位 RC 的 PME。在短期和长期结果方面，R-PME 和 L-PME 之间没有差异，手术方法的选择留给外科医生的经验。需要进行特定的卫生经济学研究来评估机器人手术在 RC 中的成本效益。
