Christiana Care Surgical Residency Program, Newark, DE, USA.
Department of Statistics, Virginia Tech, Roanoke, VA, USA.
Am Surg. 2021 Aug;87(8):1275-1279. doi: 10.1177/0003134820973384. Epub 2020 Dec 19.
Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution.
A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate.
115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51).
Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.
与腹腔镜和开放性手术相比，机器人结肠切除术可降低发病率和术后恢复速度。本项单中心的回顾性研究旨在评估基于手术方式的结肠切除术的结果。
对 2015 年至 2019 年期间，由一位经过专业培训的结肠直肠外科医生在单家机构进行的所有结肠切除术患者进行了回顾性研究，并为每种方法（开放性、腹腔镜和机器人）开发了一个队列。评估了 30 天的结果。对于二项式结果，使用单变量逻辑回归模型来量化每个感兴趣的预测因子对每种结果的可能性的单独影响。连续结果采用类似的方法；但是，适当的情况下使用线性和泊松回归模型。
共评估了 115 例患者：14%（n = 16）为开放性手术，44%（n = 51）为腹腔镜手术，42%（n = 48）为机器人手术。在这些队列中，手术时间、再次手术率、再入院率或主要并发症方面没有统计学上的显著差异。机器人结肠切除术的住院时间最短（Kruskal-Wallis <.0001），估计失血量减少（Kruskal-Wallis =.0012）。中位年龄为 63 岁（四分位距 [IQR] 53-72）。54%（n = 62）为女性。美国麻醉医师协会（ASA）身体状况分类中位数为 3 级（IQR 2-3）。中位体重指数为 28.67（IQR 25.03-33.47）。最终病理诊断为恶性的占 44%（n = 51）。
在这 3 种方法中，30 天的发病率或死亡率没有统计学上的显著差异。机器人结肠切除术的住院时间和估计失血量明显减少。
