机器人与经肛门全直肠系膜切除术对性功能、肛肠和泌尿功能的影响：一项多中心、前瞻性、观察性研究。

Robotic versus transanal total mesorectal excision in sexual, anorectal, and urinary function: a multicenter, prospective, observational study.

机构信息

Department of General, Visceral and Thoracic Surgery, University Medical Centre of Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

出版信息

Int J Colorectal Dis. 2021 Dec;36(12):2749-2761. doi: 10.1007/s00384-021-04030-5. Epub 2021 Sep 18.

PURPOSE

Improved long-term survival after low anterior resection (LAR) for rectal cancer highlights the importance of functional outcome. Urogenital and anorectal dysfunction is frequently reported after conventional LAR. Advanced minimally invasive techniques such as robotic (RoTME) and transanal total mesorectal excision (TaTME) might improve functional results by precisely dissecting and preserving autonomic nerves. We compared functional outcomes after RoTME or TaTME in a multicenter study.

METHODS

One hundred twenty patients (55 RoTME/65 TaTME) were prospectively included in four participating centers. Anorectal (Wexner and low anterior resection syndrome (LARS) Score), urinary (International Consultation on Incontinence-Male/Female Lower Urinary Tract Symptoms Score (ICIQ-MLUTS/ICIQ-FLUTS) and International Prostate Symptom Scale (IPSS)), and sexual (International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI)) outcomes at 12 months after surgery were compared to preoperative scores. The response rate to the 1-year postoperative functional assessment by questionnaire was 79.5%.

RESULTS

RoTME enabled better anorectal function compared to TaTME (LARS score 4.3 ± 2.2 vs. 9.8 ± 1.5, p = 0.038, respectively). TaTME proved superior at preserving male urinary function, while female urinary function was comparable in both groups, with only mild postoperative impairment (RoTME vs. TaTME, respectively: ICIQ-MLUTS 13.8 ± 4.9 vs. 1.8 ± 5.8, p = 0.038; ICIQ-FLUTS Incontinence Score - 0.3 ± 1.0 vs. - 0.2 ± 0.9, p = 0.844). Both techniques demonstrated comparable male (RoTME - 13.4 ± 2.7 vs. TaTME - 11.7 ± 3.4, p = 0.615) and female (RoTME 5.2 ± 4.6 vs. TaTME 10.5 ± 6.4, p = 0.254) sexual function.

CONCLUSION

After adjustment for risk factors, RoTME provided better anorectal functional results, whereas TaTME was better at preserving male urinary function. Overall, both techniques demonstrated only mild postoperative functional impairment.

目的

低位前切除术（LAR）治疗直肠癌后长期生存率的提高突出了功能结果的重要性。传统 LAR 后常出现泌尿和肛门直肠功能障碍。先进的微创技术，如机器人（RoTME）和经肛门全直肠系膜切除术（TaTME），通过精确地解剖和保留自主神经，可能改善功能结果。我们在一项多中心研究中比较了 RoTME 或 TaTME 后的功能结果。

方法

前瞻性纳入四家参与中心的 120 例患者（55 例 RoTME/65 例 TaTME）。在术后 12 个月时比较肛门直肠（Wexner 和低位前切除综合征（LARS）评分）、泌尿（国际尿失禁咨询委员会-男性/女性下尿路症状评分（ICIQ-MLUTS/ICIQ-FLUTS）和国际前列腺症状评分（IPSS））和性功能（国际勃起功能指数（IIEF），女性性功能指数（FSFI））与术前评分的结果。通过问卷调查对术后 1 年的功能评估进行了 79.5%的应答率。

结果

与 TaTME 相比，RoTME 能更好地改善肛门直肠功能（LARS 评分分别为 4.3±2.2 和 9.8±1.5，p=0.038）。TaTME 在保留男性尿功能方面表现更好，而女性尿功能在两组中相当，只有轻微的术后损伤（RoTME 与 TaTME 分别为：ICIQ-MLUTS 13.8±4.9 与 1.8±5.8，p=0.038；ICIQ-FLUTS 失禁评分分别为-0.3±1.0 与-0.2±0.9，p=0.844）。两种技术均显示出类似的男性（RoTME-13.4±2.7 与 TaTME-11.7±3.4，p=0.615）和女性（RoTME 5.2±4.6 与 TaTME 10.5±6.4，p=0.254）性功能。