Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia.
Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
J Robot Surg. 2022 Aug;16(4):927-933. doi: 10.1007/s11701-021-01319-z. Epub 2021 Oct 28.
Robotic right hemicolectomy (RRC) may have technical advantages over the conventional laparoscopic right colectomy (LRC) due to higher degrees of rotation, articulation, and tri-dimensional imaging. There is growing literature describing advantages of RRC compared to LRC; however, there is a lack of evidence about safety, oncologic quality of surgery and cost. This study aimed to analyse complication rates, length of stay and nodal harvest in patients undergoing minimally invasive right hemicolectomy for colon cancer from a prospective Australasian colorectal cancer database. This was a retrospective cohort study using nearest neighbour matching. The Binational Colorectal Cancer Audit (BCCA) provided the data for analysis. The primary outcome was length of stay. Secondary outcomes were harvested lymph node count, anastomotic leak, postoperative haemorrhage, abdominal abscess, postoperative ileus, wound infections and non-surgical complications. 4977 patients who underwent robotic (n = 146) or laparoscopic (n = 4831) right hemicolectomy for right-sided colon cancer were included. For RRC, LOS was shorter (5 vs 6.9 days, p = 0.01) and nodal harvest was higher (22 vs 19, p = 0.04). For RRC, surgical complications (5.9% vs 14.2%, p < 0.004) and non-surgical complications (4.6% vs 11.7%, p = 0.007) were lower though there was no difference in return to theatre or inpatient death. Robotic right hemicolectomy is associated shorter LOS and marginally higher lymph node count, though this may reflect anastomotic technique rather than surgical platform. Longer term studies are required to establish differences in overall survival, incisional hernia rates and cost effectiveness.
机器人右半结肠切除术（RRC）可能比传统腹腔镜右半结肠切除术（LRC）具有更高的旋转度、铰接度和三维成像等技术优势。越来越多的文献描述了 RRC 相对于 LRC 的优势，但关于安全性、手术肿瘤质量和成本的证据不足。本研究旨在从一个前瞻性的澳大利亚-新西兰结直肠数据库中分析接受微创右半结肠癌切除术的患者的并发症发生率、住院时间和淋巴结采集情况。这是一项回顾性队列研究，采用最近邻居匹配法。全国结直肠癌审计（BCCA）提供了分析数据。主要结局是住院时间。次要结局是淋巴结采集量、吻合口漏、术后出血、腹部脓肿、术后肠梗阻、伤口感染和非手术并发症。共纳入 4977 例接受机器人（n=146）或腹腔镜（n=4831）右半结肠切除术的右半结肠癌患者。对于 RRC，住院时间更短（5 天 vs 6.9 天，p=0.01），淋巴结采集量更高（22 个 vs 19 个，p=0.04）。对于 RRC，手术并发症（5.9% vs 14.2%，p<0.004）和非手术并发症（4.6% vs 11.7%，p=0.007）较低，但再次手术或住院期间死亡无差异。机器人右半结肠切除术与较短的住院时间和略高的淋巴结计数相关，但这可能反映了吻合技术而不是手术平台。需要进行更长期的研究来确定总体生存率、切口疝发生率和成本效益的差异。
