Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Asian J Endosc Surg. 2022 Oct;15(4):753-764. doi: 10.1111/ases.13075. Epub 2022 May 12.
The advantages of robotic-assisted laparoscopic surgery (RALS) for rectal cancer remain controversial. This study clarified and compared the short-term outcomes of RALS for rectal cancer with those of conventional laparoscopic surgery (CLS).
The records of 303 consecutive patients who underwent RALS or CLS for rectal adenocarcinoma between November 2016 and November 2021 were analyzed using propensity score-matched analysis. After matching, 188 patients were enrolled in our study to compare short-term outcomes, such as operative results, postoperative complications, and pathological findings, in each group.
After matching, baseline characteristics were comparable between groups. Although operative time in the RALS group was significantly longer than in the CLS group (p < 0.0001), the conversion rate to open laparotomy and the postoperative complication rate in the RALS group were significantly lower than in the CLS group (p = 0.0240 and p = 0.0109, respectively). Blood loss was comparable between groups. In the RALS group, postoperative hospital stay and days to soft diet were significantly shorter than those in the CLS group (p = 0.0464 and p < 0.0001, respectively). No postoperative mortality was observed in either group and significant differences were observed in resection margins and number of lymph nodes harvested.
Robotic-assisted laparoscopic surgery for rectal cancer was safe, technically feasible, and had acceptable short-term outcomes. Further studies are required to validate long-term oncological outcomes.
机器人辅助腹腔镜手术(RALS)治疗直肠癌的优势仍存在争议。本研究旨在阐明并比较 RALS 与传统腹腔镜手术(CLS)治疗直肠腺癌的短期疗效。
本研究回顾性分析了 2016 年 11 月至 2021 年 11 月期间 303 例连续接受 RALS 或 CLS 治疗的直肠腺癌患者的临床资料。采用倾向评分匹配分析,对两组患者的手术结果、术后并发症及病理发现等短期疗效进行比较,最终纳入 188 例患者进行匹配。
匹配后,两组患者的基线特征具有可比性。虽然 RALS 组的手术时间明显长于 CLS 组(p < 0.0001),但 RALS 组中转开腹率和术后并发症发生率明显低于 CLS 组(p=0.0240 和 p=0.0109)。两组患者的术中出血量无显著差异。RALS 组患者的术后住院时间和开始软食时间均明显短于 CLS 组(p=0.0464 和 p < 0.0001)。两组患者均无术后死亡病例,两组患者的切缘和淋巴结清扫数目均无显著差异。
RALS 治疗直肠癌安全可行,具有良好的短期疗效。需要进一步研究以验证其长期肿瘤学疗效。