Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Department of Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.
J Robot Surg. 2022 Feb;16(1):149-157. doi: 10.1007/s11701-021-01206-7. Epub 2021 Mar 11.
Laparoscopic surgery for rectal cancer is technically challenging. Robotic and transanal TME (TaTME) are both novel approaches developed to provide better visualization and dissection. We aim to combine both approaches in a hybrid procedure and evaluate the feasibility as well as patient and oncological outcomes in this study. A review of a prospectively maintained database of patients who underwent a hybrid abdominal robotic approach with TaTME for rectal cancer between January 2016 and October 2018 was undertaken. Patient demographics, tumor characteristics and surgical outcomes were recorded and analyzed. A total of 69 patients (43 males, 26 females) received this hybrid approach. Their median age was 58 years (range 35-87) with a mean BMI of 24.3 kg/m (range 16.4-44.2). Median distance from anal verge was 5 cm (range 2-9). The patients had a median hospital length of stay of 7 days (range 5-28). Complication rate was 17.4% (12 patients) with 3 patients (4.3%) requiring a reoperation. TME quality was optimal with all of them either complete (81.2%) or almost complete (18.8%). 65 patients (94.2%) had an R0 resection with 4 patients (5.8%) with involved circumferential resection margins (≤ 1 mm). The median number of lymph nodes harvested was 20 (range 6-37). After a median follow-up of 27.7 months (range 7-42), local recurrence was identified in 2 patients (4%). Three patients (5.2%) had distant recurrence at the 3-year mark. Hybrid robotic abdominal dissection with transanal TME for rectal cancer appears to be feasible with comparable surgical outcomes to other traditional approaches.
腹腔镜直肠癌手术具有一定的技术挑战性。机器人和经肛门全直肠系膜切除术（TaTME）是两种新的方法，旨在提供更好的可视化和解剖效果。本研究旨在结合这两种方法，采用混合手术，并评估其可行性以及患者和肿瘤学结局。我们对 2016 年 1 月至 2018 年 10 月期间接受腹部机器人 TaTME 混合手术治疗直肠癌的患者前瞻性数据库进行了回顾性分析。记录并分析了患者的人口统计学特征、肿瘤特征和手术结果。共 69 例患者（男性 43 例，女性 26 例）接受了这种混合方法。他们的中位年龄为 58 岁（范围 35-87 岁），平均 BMI 为 24.3kg/m（范围 16.4-44.2）。中位肛缘距离为 5cm（范围 2-9cm）。患者的中位住院时间为 7 天（范围 5-28 天）。并发症发生率为 17.4%（12 例），其中 3 例（4.3%）需要再次手术。TME 质量均为最佳，其中完全（81.2%）或几乎完全（18.8%）。65 例（94.2%）患者行 RO 切除术，4 例（5.8%）患者切缘受累（≤1mm）。中位淋巴结清扫数为 20 枚（范围 6-37 枚）。中位随访 27.7 个月（范围 7-42 个月）后，2 例（4%）患者出现局部复发。3 例（5.2%）患者在 3 年时出现远处复发。对于直肠癌，采用混合机器人腹部解剖与经肛门全直肠系膜切除术是可行的，其手术结果与其他传统方法相当。
