Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 ShimonagakuboNagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Surg Today. 2022 Jan;52(1):120-128. doi: 10.1007/s00595-021-02313-6. Epub 2021 Jun 10.
Clinical evidence demonstrating risk factors for anastomotic leakage including robotic staplers has remained limited, even though the use of robotic surgery has increased substantially. The purpose of this study was to evaluate the effects of robotic staplers on symptomatic anastomotic leakage in robotic low anterior resection for rectal cancer.
A total of 427 consecutive patients with primary rectal cancer who underwent robotic low anterior resection without diverting stoma were investigated retrospectively. Symptomatic anastomotic leakage was defined as anastomotic leakage of Clavien-Dindo Grade ≥ II. We compared the symptomatic anastomotic leakage rates between manual and robotic staplers using propensity score matching and investigated the risk factors for symptomatic anastomotic leakage.
After propensity score matching, 168 pairs of manual and robotic stapler cases were selected. The symptomatic anastomotic leakage rate was significantly higher for manual staplers (6.5%) than for robotic staplers (1.2%, p = 0.02). In a multivariate analysis, the use of a manual stapler (p = 0.04, OR 4.86, 95% CI 1.08-21.8) and anastomosis < 4 cm from the anal verge (p < 0.01, OR 4.36, 95% CI 1.48-12.9) were identified as independent risk factors for symptomatic anastomotic leakage.
Robotic stapler use was associated with a significantly decreased rate of anastomotic leakage in robotic low anterior resection without diverting stoma for rectal cancer.
尽管机器人手术的应用已经大幅增加，但仍缺乏证明包括机器人吻合器在内的吻合口漏发生风险因素的临床证据。本研究旨在评估机器人吻合器对直肠癌机器人低位前切除术吻合口漏的影响。
回顾性分析了 427 例连续接受无转流造口机器人低位前切除术的原发性直肠癌患者。症状性吻合口漏定义为吻合口漏 Clavien-Dindo 分级≥Ⅱ级。我们使用倾向评分匹配比较了手动吻合器和机器人吻合器的症状性吻合口漏发生率，并探讨了症状性吻合口漏的危险因素。
经过倾向评分匹配，选择了 168 对手动和机器人吻合器病例。手动吻合器的症状性吻合口漏发生率（6.5%）显著高于机器人吻合器（1.2%，p=0.02）。多因素分析显示，使用手动吻合器（p=0.04，OR 4.86，95%CI 1.08-21.8）和吻合口距离肛缘<4cm（p<0.01，OR 4.36，95%CI 1.48-12.9）是症状性吻合口漏的独立危险因素。
在无转流造口的直肠癌机器人低位前切除术中，使用机器人吻合器与吻合口漏发生率显著降低相关。
