Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Danderyd, Sweden.
Department of Surgery, Örebro & Institute of Molecular Medicine and Surgery, Örebro University and University Hospital, Karolinska Institutet, Stockholm, Sweden.
Surg Endosc. 2022 Mar;36(3):2006-2017. doi: 10.1007/s00464-021-08486-y. Epub 2021 Apr 15.
Advantages of robotic technique over laparoscopic technique in rectal tumor surgery have yet to be proven. Large multicenter, register-based cohort studies within an optimized perioperative care protocol are lacking. The aim of this retrospective cohort study was to compare short-term outcomes in robotic, laparoscopic and open rectal tumor resections, while also determining compliance to the enhanced recovery after surgery (ERAS)®Society Guidelines.
All patients scheduled for rectal tumor resection and consecutively recorded in the Swedish part of the international ERAS® Interactive Audit System between January 1, 2010 to February 27, 2020, were included (N = 3125). Primary outcomes were postoperative complications and length of stay (LOS) and secondary outcomes compliance to the ERAS protocol, conversion to open surgery, symptoms delaying discharge and reoperations. Uni- and multivariate comparisons were used.
Robotic surgery (N = 827) had a similar rate of postoperative complications (Clavien-Dindo grades 1-5), 35.9% compared to open surgery (N = 1429) 40.9% (OR 1.15, 95% CI (0.93, 1.41)) and laparoscopic surgery (N = 869) 31.2% (OR 0.88, 95% CI (0.71, 1.08)). LOS was longer in the open group, median 9 days (IRR 1.35, 95% CI (1.27, 1.44)) and laparoscopic group, 7 days (IRR 1.14, 95% CI (1.07, 1.21)) compared to the robotic group, 6 days. Pre- and intraoperative compliance to the ERAS protocol were similar between groups.
In this multicenter cohort study, robotic surgery was associated with shorter LOS compared to both laparoscopic and open surgery and had lower conversion rates vs laparoscopic surgery. The rate of complications was similar between groups.
机器人技术在直肠肿瘤手术中相对于腹腔镜技术的优势尚未得到证实。缺乏基于优化围手术期护理方案的大型多中心、注册队列研究。本回顾性队列研究的目的是比较机器人、腹腔镜和开放性直肠肿瘤切除术的短期结果，并确定是否符合术后加速康复（ERAS）协会指南。
纳入 2010 年 1 月 1 日至 2020 年 2 月 27 日期间连续记录在国际 ERAS 交互式审核系统瑞典部分的所有计划进行直肠肿瘤切除术的患者（N=3125）。主要结局是术后并发症和住院时间（LOS），次要结局是 ERAS 方案的依从性、转为开放性手术、延迟出院的症状和再次手术。采用单因素和多因素比较。
机器人手术（N=827）的术后并发症发生率（Clavien-Dindo 分级 1-5）与开放性手术（N=1429）相似，为 35.9%（OR 1.15，95%CI（0.93，1.41）），与腹腔镜手术（N=869）相似，为 31.2%（OR 0.88，95%CI（0.71，1.08））。开放性组的 LOS 较长，中位数为 9 天（IRR 1.35，95%CI（1.27，1.44）），腹腔镜组为 7 天（IRR 1.14，95%CI（1.07，1.21）），而机器人组为 6 天。各组的术前和术中 ERAS 方案依从性相似。
在这项多中心队列研究中，与腹腔镜和开放性手术相比，机器人手术与较短的 LOS 相关，且与腹腔镜手术相比，转换率较低。各组的并发症发生率相似。
