Abdalla Solafah, Lupinacci Renato M, Genova Pietro, Oberlin Olivier, Goasguen Nicolas, Fabiani Bettina, Valverde Alain
Department of Digestive Surgery and Surgical Oncology, AP-HP, Hôpital Bicêtre, Université Paris Saclay, Le Kremlin Bicêtre, France.
Department of Digestive, Oncologic and Metabolic Surgery, AP-HP, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92104, Boulogne-Billancourt Cedex, France.
Surg Endosc. 2022 May;36(5):3558-3566. doi: 10.1007/s00464-021-08679-5. Epub 2021 Aug 16.
Although minimally invasive rectal surgery (MIRS) for cancer provides better recovery for similar oncologic outcomes over open approach, conversion is still required in 10% and its impact on short-term and long-term outcomes remains unclear. The aim of our study was to evaluate the impact of conversion on postoperative and oncologic outcomes in patients undergoing MIRS for cancer.
From June 2011 to March 2020, we reviewed 257 minimally invasive rectal resections for cancer recorded in a prospectively maintained database, with 192 robotic and 65 laparoscopic approaches. Patients who required conversion to open (Conversion group) were compared to those who did not have conversion (No conversion group) in terms of short-term, histologic, and oncologic outcomes. Univariate and multivariate analyses of the risk factors for postoperative morbidity were performed.
Eighteen patients (7%) required conversion. The conversion rate was significantly higher in the laparoscopic approach than in the robotic approach (16.9% vs 3.6%, p < 0.01). Among the 4 reactive conversions, 3 (75%) were required during robotic resections. Patients in the Conversion group had a higher morbidity rate (83.3% vs 43.1%, p = 0.01) and more severe complications (38.9%, vs 18.8%, p = 0.041). Male sex [HR = 2.46, 95%CI (1.41-4.26)], total mesorectal excision [HR = 2.89, 95%CI (1.57-5.320)], and conversion (HR = 4.87, 95%CI [1.34-17.73]) were independently associated with a higher risk of overall 30-day morbidity. R1 resections were more frequent in the Conversion group (22.2% vs 5.4%, p = 0.023) without differences in the overall (82.7 ± 7.0 months vs 79.4 ± 3.3 months, p = 0.448) and disease-free survivals (49.0 ± 8.6 months vs 70.2 ± 4.1 months, p = 0.362).
Conversion to laparotomy during MIRS for cancer was associated with poorer postoperative results without impairing oncologic outcomes. The high frequency of reactive conversion due to intraoperative complications in robotic resections confirmed that MIRS for cancer is a technically challenging procedure.
尽管用于治疗癌症的微创直肠手术（MIRS）相较于开放手术能在相似的肿瘤学治疗效果下实现更好的恢复，但仍有10%的患者需要转为开放手术，其对短期和长期治疗效果的影响尚不清楚。我们研究的目的是评估转为开放手术对接受MIRS治疗癌症患者术后及肿瘤学治疗效果的影响。
2011年6月至2020年3月，我们回顾了前瞻性维护数据库中记录的257例微创直肠癌切除术，其中192例采用机器人手术，65例采用腹腔镜手术。将需要转为开放手术的患者（转为开放手术组）与未转为开放手术的患者（未转为开放手术组）在短期、组织学和肿瘤学治疗效果方面进行比较。对术后发病的危险因素进行单因素和多因素分析。
18例患者（7%）需要转为开放手术。腹腔镜手术的转为开放手术率显著高于机器人手术（16.9%对3.6%，p<0.01）。在4例被动转为开放手术中，3例（75%）是在机器人切除术中需要的。转为开放手术组患者的发病率更高（83.3%对43.1%，p=
