保肛机器人全直肠系膜切除术与腹腔镜全直肠系膜切除术相比，可为男性中低位直肠癌患者提供更好的直肠系膜标本和良好的肿瘤局部控制效果。

Sphincter-Saving Robotic Total Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal Cancer.

机构信息

Department of General Surgery, Bosphorus Clinical Research Academy, Istanbul, Turkey.

Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey.

出版信息

Surg Technol Int. 2021 May 20;38:160-166. doi: 10.52198/21.STI.38.CR1391.

DOI:10.52198/21.STI.38.CR1391

PMID:33537982

Abstract

INTRODUCTION

Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer.

MATERIALS AND METHODS

The study was conducted as a retrospective review of a prospectively maintained database. One-hundred-three robotic and 84 laparoscopic sphincter-saving total mesorectal excisions were performed by a single surgeon between January 2011 and January 2020. Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups.

RESULTS

The patients' characteristics did not differ significantly between the two groups. Median operating time was longer in the robotic than in the laparoscopic group (180 minutes versus 140 minutes, p=0.033). Macroscopic grading of the specimen in the robotic group was complete in 96 (93.20%), near complete in four (3.88%) and incomplete in three (2.91%) patients. In the laparoscopic group, grading was complete in 37 (44.04%), near complete in 40 (47.61%) and incomplete in seven (8.33%) patients (p=0.03). The median length of follow up was 48 (9-102) months in the robotic, and 75.6 (11-113) months in the laparoscopic group. Overall, five-year survival was 87% in the robotic and 85.3% in the laparoscopic groups. Local recurrence rates were 3.8% and 7.14%, respectively, in the robotic and laparoscopic groups (p<0.05).

CONCLUSION

Sphincter-saving robotic total mesorectal excision is a safe and feasible tool, which provides good mesorectal integrity and better local control in male patients with mid-low rectal cancer.

摘要

介绍

腹腔镜直肠全系膜切除术是一项技术上具有挑战性的手术，传统腹腔镜存在一定的局限性。手术机器人系统可能有助于克服其中的一些局限性。我们的研究旨在比较机器人和腹腔镜保肛直肠全系膜切除术治疗男性中低位直肠癌的长期肿瘤学结果。

材料和方法

该研究是对前瞻性维护数据库的回顾性分析。一位外科医生于 2011 年 1 月至 2020 年 1 月期间分别进行了 103 例机器人和 84 例腹腔镜保肛直肠全系膜切除术。比较两组患者的特征、围手术期恢复、术后并发症、病理结果和肿瘤学结果。

结果

两组患者的特征无显著差异。机器人组的中位手术时间长于腹腔镜组（180 分钟比 140 分钟，p=0.033）。机器人组标本的宏观分级中，完全分级 96 例（93.20%），接近完全分级 4 例（3.88%），不完全分级 3 例（2.91%）。腹腔镜组中，完全分级 37 例（44.04%），接近完全分级 40 例（47.61%），不完全分级 7 例（8.33%）（p=0.03）。机器人组的中位随访时间为 48（9-102）个月，腹腔镜组为 75.6（11-113）个月。总的来说，机器人组和腹腔镜组的五年生存率分别为 87%和 85.3%。机器人组和腹腔镜组的局部复发率分别为 3.8%和 7.14%（p<0.05）。