Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway.
Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway.
Surg Endosc. 2022 May;36(5):3574-3584. doi: 10.1007/s00464-021-08681-x. Epub 2021 Aug 18.
Conversion from laparoscopic to open access colorectal surgery is associated with a poorer postoperative outcome. The aim of this study was to assess conversion rates and outcomes after standard laparoscopic rectal resection (LR) and robotic laparoscopic rectal resection (RR).
A national 5-year cohort study utilizing prospectively recorded data on patients who underwent elective major laparoscopic resection for rectal cancer. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry. Primary end point was conversion rate. Secondary end points were postoperative complications within 30 days and histopathological results. Chi-square test, two-sided T test, and Mann-Whitney U test were used for univariable analyses. Both univariable and multivariable logistic regression analyses were used to analyze the relations between different predictors and outcomes, and propensity score matching was performed to address potential treatment assignment bias.
A total of 1284 patients were included, of whom 375 underwent RR and 909 LR. Conversion rate was 8 out of 375 (2.1%) for RR compared with 87 out of 909 (9.6%) for LR (p < 0.001). RR was associated with reduced risk for conversion compared with LR (aOR 0.22, 95% CI 0.10-0.46). There were no other outcome differences between RR and LR. Factors associated with increased risk for conversion were male gender, severe cardiac disease and BMI > 30. Conversion was associated with higher rates of major complications (20 out of 95 (21.2%) vs 135 out of 1189 (11.4%) p = 0.005), reoperations (13 out of 95 (13.7%) vs 93 out of 1189 (7.1%) p = 0.020), and longer hospital stay (median 8 days vs 6 days, p = 0.001).
Conversion rate was lower with robotic assisted rectal resections compared with conventional laparoscopy. Conversions were associated with higher rates of postoperative complications.
从腹腔镜转为开放式结直肠手术与较差的术后结果相关。本研究旨在评估标准腹腔镜直肠切除术（LR）和机器人腹腔镜直肠切除术（RR）后的转换率和结果。
一项利用前瞻性记录的接受择期腹腔镜直肠切除术治疗直肠癌患者数据的全国 5 年队列研究。数据来自挪威胃肠外科登记处和挪威结直肠癌登记处。主要终点是转化率。次要终点是术后 30 天内的并发症和组织病理学结果。采用卡方检验、双侧 T 检验和曼-惠特尼 U 检验进行单变量分析。采用单变量和多变量逻辑回归分析来分析不同预测因子与结果之间的关系，并进行倾向评分匹配以解决潜在的治疗分配偏差。
共纳入 1284 例患者，其中 375 例接受 RR，909 例接受 LR。RR 的转化率为 8/375（2.1%），LR 为 87/909（9.6%）（p<0.001）。RR 与 LR 相比，转化率降低的风险降低（OR 0.22，95%CI 0.10-0.46）。RR 和 LR 之间没有其他结果差异。与转化率增加相关的因素是男性、严重心脏疾病和 BMI>30。转换与更高的主要并发症发生率相关（95 例中有 20 例[21.2%]与 1189 例中有 135 例[11.4%]相比，p=0.005）、再次手术（95 例中有 13 例[13.7%]与 1189 例中有 93 例[7.1%]相比，p=0.020）和更长的住院时间（中位数 8 天与 6 天，p=0.001）。
与传统腹腔镜相比，机器人辅助直肠切除术的转化率较低。转换与更高的术后并发症发生率相关。
