Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy.
Updates Surg. 2022 Feb;74(1):127-135. doi: 10.1007/s13304-021-01159-4. Epub 2021 Sep 14.
The role of minimally invasive surgery in the treatment of transverse colon cancer is still controversial. The aim of this study is to investigate the advantages of a totally laparoscopic technique comparing open versus laparoscopic/robotic approach. Three hundred and eighty-eight patients with transverse colon cancer, treated with a segmental colon resection, were retrospectively analyzed. Demographic data, tumor stage, operative time, intraoperative complications, number of harvested lymph nodes and recovery outcomes were recorded. Recurrences and death were also evaluated during the follow-up. No differences were found between conventional and minimally invasive surgery, both for oncological long-term outcomes (recurrence rate p = 0.28; mortality p = 0.62) and postoperative complications (overall rate p = 0.43; anemia p = 0.78; nausea p = 0.68; infections p = 0.91; bleeding p = 0.62; anastomotic leak p = 0.55; ileus p = 0.75). Nevertheless, recovery outcomes showed statistically significant differences in favor of minimally invasive surgery in terms of time to first flatus (p = 0.001), tolerance to solid diet (p = 0.017), time to first mobilization (p = 0.001) and hospital stay (p = 0.004). Compared with laparoscopic approach, robotic surgery showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.005) and tolerance to solid diet (p = 0.001). Finally, anastomosis evaluation confirmed the superiority of intracorporeal approach which showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.003) and tolerance to solid diet (p = 0.001); moreover, we recorded a statistical difference in favor of intracorporeal approach for infection rate (p = 0.04), bleeding (p = 0.001) and anastomotic leak (p = 0.03). Minimally invasive approach is safe and effective as the conventional open surgery, with comparable oncological results but not negligible advantages in terms of recovery outcomes. Moreover, we demonstrated that robotic approach may be considered a valid option and an intracorporeal anastomosis should always be preferred.
微创手术在横结肠癌治疗中的作用仍存在争议。本研究旨在探讨全腹腔镜技术与开腹手术和腹腔镜/机器人手术相比的优势。对 388 例接受节段性结肠切除术的横结肠癌患者进行回顾性分析。记录人口统计学数据、肿瘤分期、手术时间、术中并发症、淋巴结清扫数目和恢复结果。在随访期间还评估了复发和死亡情况。常规手术和微创手术在肿瘤长期预后（复发率 p=0.28；死亡率 p=0.62）和术后并发症（总发生率 p=0.43；贫血 p=0.78；恶心 p=0.68；感染 p=0.91；出血 p=0.62；吻合口漏 p=0.55；肠梗阻 p=0.75）方面均无差异。然而，恢复结果显示微创手术在首次排气时间（p=0.001）、固体饮食耐受时间（p=0.017）、首次活动时间（p=0.001）和住院时间（p=0.004）方面具有统计学显著优势。与腹腔镜方法相比，机器人手术在首次排气时间（p=0.001）、首次活动时间（p=0.005）和固体饮食耐受时间（p=0.001）方面的结果更好。最后，吻合口评估证实了腔内方法的优势，腔内方法在首次排气时间（p=0.001）、首次活动时间（p=0.003）和固体饮食耐受时间（p=0.001）方面的结果更好；此外，我们记录到腔内方法在感染率（p=0.04）、出血（p=0.001）和吻合口漏（p=0.03）方面具有统计学优势。微创手术与传统开腹手术一样安全有效，具有相似的肿瘤学结果，但在恢复结果方面具有不可忽视的优势。此外，我们证明机器人手术可能是一种有效的选择，并且应始终首选腔内吻合。
