Suppr超能文献

机器人与腹腔镜低位前切除术治疗局部进展期 II-III 期直肠癌新辅助放化疗后:单中心队列研究。

Robotic versus laparoscopic low anterior resection following neoadjuvant chemoradiation therapy for stage II-III locally advanced rectal cancer: a single-centre cohort study.

机构信息

Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.

出版信息

J Robot Surg. 2022 Oct;16(5):1133-1141. doi: 10.1007/s11701-021-01351-z. Epub 2022 Jan 9.

Abstract

Neoadjuvant chemo-radiotherapy (nCRT) of locally advanced rectal cancer is associated with challenging surgical treatment and increased postoperative morbidity. Robotic technology overcomes laparoscopy limitations by enlarged 3D view, improved anatomical transection accuracy, and physiologic tremor reduction. Patients with UICC stage II-III rectal cancer, consecutively referred to our institution between March 2015 and June 2020 (n = 102) were treated with robotic (Rob-G, n = 38) or laparoscopic (Lap-G, n = 64) low anterior resection (LAR) for total meso-rectal excision (TME) following highly standardized and successful nCRT treatment. Feasibility, conversion rates, stoma creation, morbidity and clinical/pathological outcome were comparatively analysed. Sex, age, BMI, ASA scores, cTN stages and tumour distance from dentate line were comparable in the two groups. Robotic resection was always feasible without conversion to open surgery, which was necessary in 11/64 (17%) Lap-G operations (p = 0.006). Primary or secondary stomata were created in 17/38 (45%) Rob-G and 52/64 (81%) Lap-G patients (p < 0.001). Major morbidity occurred in 7/38 (18.4%) Rob-G and 6/64 (9.3%) Lap-G patients (p = 0.225). Although median operation time was longer in Rob-G compared with Lap-G (376; IQR: 330-417 min vs. 300; IQR: 270-358 min; p < 0.001), the difference was not significant in patients (Rob-G, n = 6; Lap-G, n = 10) with ≥30 BMI (p = 0.106). Number of resected lymph nodes, ypTN staging and circumferential resection margins (CRM) were comparable. Resection was complete in 87% of Rob-G and 89% of Lap-G patients (p = 0.750). Robotic LAR is not inferior to laparoscopic LAR following nCRT. Larger, randomized studies are needed to confirm lower conversion in robotic, compared to laparoscopic resection.

摘要

局部进展期直肠癌的新辅助放化疗(nCRT)与具有挑战性的手术治疗和增加术后发病率有关。机器人技术通过扩大的 3D 视图、改善的解剖横切准确性和生理震颤减少克服了腹腔镜的局限性。2015 年 3 月至 2020 年 6 月连续转至我院的 UICC 分期 II-III 期直肠癌患者(n=102)接受了机器人(Rob-G,n=38)或腹腔镜(Lap-G,n=64)低位前切除术(LAR),用于全直肠系膜切除(TME)治疗后高度标准化和成功的 nCRT 治疗。比较分析了可行性、转化率、造口术、发病率和临床/病理结果。两组患者的性别、年龄、BMI、ASA 评分、cTN 分期和肿瘤距齿状线的距离均相似。机器人切除总是可行的,无需转为开放性手术,而 Lap-G 中有 11/64(17%)例需要转为开放性手术(p=0.006)。Rob-G 中有 17/38(45%)例和 Lap-G 中有 52/64(81%)例患者需要创建原发性或继发性造口(p<0.001)。Rob-G 中有 7/38(18.4%)例和 Lap-G 中有 6/64(9.3%)例患者发生主要发病率(p=0.225)。虽然 Rob-G 中的中位手术时间长于 Lap-G(376;IQR:330-417 分钟与 300;IQR:270-358 分钟;p<0.001),但在 BMI≥30 的患者(Rob-G,n=6;Lap-G,n=10)中差异无统计学意义(p=0.106)。切除的淋巴结数量、ypTN 分期和环周切缘(CRM)相似。Rob-G 中有 87%的患者和 Lap-G 中有 89%的患者完成了完全切除(p=0.750)。nCRT 后,机器人辅助 LAR 并不逊于腹腔镜辅助 LAR。需要更大的、随机研究来证实机器人切除较腹腔镜切除的转化率更低。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验