Zhang X Q, Cao S G, Liu X D, Li Z Q, Tian Y L, Xu J F, Meng C, Li Y, Tan X J, Liu S L, Guo D, Jiao X L, Li Y, Chen D, Lyu L, Zhang J, Jiang H T, Niu Z J, Zhou Y B
Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.
Zhonghua Wai Ke Za Zhi. 2022 Feb 1;60(2):148-153. doi: 10.3760/cma.j.cn112139-20210524-00221.
To compare the short-term and long-term outcomes between robotic-assisted and laparoscopic-assisted radical right hemicolectomy in patients with adenocarcinoma of the right colon. Retrospective review of a prospectively collected database identified 288 right colon cancer patients who underwent either robotic-assisted (=57) or laparoscopic-assisted right hemicolectomy (=231) between October 2014 and October 2020 at Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University. There were 161 males and 127 females, aging (60.3±12.8) years (range: 17 to 86 years). After propensity score matching as 1∶4 between robotic-assisted and laparoscopic-assisted right hemicolectomy, there were 56 cases in robotic group and 176 cases in laparoscipic group. Perioperative outcomes and overall survival were compared between the two groups using test, Wilcoxon rank sum test, χ test, Fisher exact test, Kaplan-Meier method and Log-rank test, respectively. The total operative time was similar between the robotic and laparoscopic group ((206.9±60.7) minutes (219.9±56.3) minutes, =-1.477, =0.141). Intraoperative bleeding was less in the robotic group (50 (20) ml 50 (50) ml, =-4.591, <0.01), while the number of lymph nodes retrieved was significantly higher (36.0±10.0 29.0±10.1, =4.491, <0.01). Patients in robotic group experienced significantly shorter hospital stay, shorter time to first flatus, and defecation (: -2.888, -2.946, -2.328, all <0.05). Moreover, the overall peri-operative complication rate was similar between robotic and laparoscopic group (17.9% 22.7%, χ²=0.596,=0.465). The 3-year overall survival were 92.9% and 87.9% respectively and the 3-year disease-free survival rates were 83.1% and 82.6% with no statistical significance between the robotic and laparoscopic group (>0.05). Compared to laparoscopic-assisted right hemicolectomy, robot-assisted right hemicolectomy could improve some short-term clinical outcomes. The two procedures are both achieving comparable survival.
比较机器人辅助与腹腔镜辅助根治性右半结肠切除术治疗右半结肠癌患者的短期和长期疗效。对前瞻性收集的数据库进行回顾性分析，纳入了2014年10月至2020年10月在青岛大学附属医院胃肠外科接受机器人辅助（n = 57）或腹腔镜辅助右半结肠切除术（n = 231）的288例右半结肠癌患者。其中男性161例，女性127例，年龄（60.3±12.8）岁（范围：17至86岁）。在按照1∶4的倾向评分匹配机器人辅助与腹腔镜辅助右半结肠切除术后，机器人组有56例，腹腔镜组有176例。分别采用t检验、Wilcoxon秩和检验、χ²检验、Fisher确切概率法、Kaplan-Meier法和Log-rank检验比较两组的围手术期结局和总生存期。机器人组和腹腔镜组的总手术时间相似（（206.9±60.7）分钟 vs （219.9±56.3）分钟，t = -1.477，P = 0.141）。机器人组术中出血量较少（50（20）ml vs 50（50）ml，t = -4.591，P < 0.01），而清扫的淋巴结数量显著更多（36.0±10.0 vs 29.0±10.1，t = 4.491，P < 0.01）。机器人组患者的住院时间显著缩短，首次排气时间和排便时间也显著缩短（t值分别为：-2.888、-2.946、-2.328，均P < 0.05）。此外，机器人组和腹腔镜组的总体围手术期并发症发生率相似（17.9% vs 22.7%，χ² = 0.596，P = 0.465）。机器人组和腹腔镜组的3年总生存率分别为92.9%和87.9%，3年无病生存率分别为83.1%和82.6%，差异无统计学意义（P > 0.05）。与腹腔镜辅助右半结肠切除术相比，机器人辅助右半结肠切除术可改善一些短期临床结局。两种手术方式的生存效果相当。
