男性机器人辅助与腹腔镜全直肠系膜切除术治疗直肠癌后泌尿生殖功能：前瞻性队列研究。
Male urogenital function after robot-assisted and laparoscopic total mesorectal excision for rectal cancer: a prospective cohort study.
机构信息
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, China.
Nanchang University Medical College, Jiangxi, Nanchang, China.
出版信息
BMC Surg. 2022 May 14;22(1):185. doi: 10.1186/s12893-022-01592-1.
BACKGROUND
Urogenital dysfunction is recognized as a serious complication affecting patient quality of life after rectal cancer surgery to treat rectal cancer; however, the studies focus on the urogenital function after robot-assisted rectal cancer surgery compared to laparoscopic surgery are limited.
METHODS
Male patients undergoing robotic total mesorectal excision (R-TME) or laparoscopic total mesorectal excision (L-TME) were prospectively enrolled. The International Prostate Symptom Score (IPSS) and the five-item version of the International Index of Erectile Function (IIEF-5) scale were used to compare the urogenital function of the two groups preoperatively and 3, 6, and 12 months postoperatively.
RESULTS
Eighty-nine patients who planned to undergo R-TME and L-TME were prospectively enrolled; 77 patients of these patients (86.5%) completed all questionnaires at all time points and were thus included in the final analysis. Of the included patients, 38 underwent R-TME and 39 underwent L-TME. There was no significant difference in age, BMI, American Society of Anesthesiologists (ASA) score, tumor location, neoadjuvant therapy, operation method, postoperative pathological results and adjuvant therapy between the two groups. Preoperative urogenital function was similar in both groups; however, the IPSS was significantly lower in R-TME patients than that in T-TME patients at 6 months and 12 months [(7.82 ± 2.25 vs. 9.95 ± 3.01, P = 0.006; 7.62 ± 2.5 vs. 9.12 ± 2.64, P = 0.012)]. IIEF-5 scores decreased 3 months after R-TME and L-TME surgery (14.87 ± 3.27 vs. 13.92 ± 3.62, p = 0.231) and then gradually increased; at 12 months, IIEF-5 scores were comparable to those at baseline in both groups. IIEF-5 scores were higher in R-TME patients than those in L-TME patients at 6 months (18.55 ± 3.45 vs. 16.75 ± 3.26, P = 0.021), but there was no significant difference between the two groups at 12 months (21.22 ± 3.06 vs. 19.95 ± 3.03, P = 0.071).
CONCLUSIONS
The robotic approach for TME was associated with more rapid restoration of male urogenital function than the laparoscopic approach.
背景
泌尿生殖功能障碍是一种严重的并发症，会影响直肠癌手术后患者的生活质量；然而，目前关于机器人辅助直肠癌手术与腹腔镜手术相比对泌尿生殖功能影响的研究有限。
方法
前瞻性纳入接受机器人全直肠系膜切除术（R-TME）或腹腔镜全直肠系膜切除术（L-TME）的男性患者。使用国际前列腺症状评分（IPSS）和国际勃起功能指数-5 项简表（IIEF-5）评分比较两组患者术前和术后 3、6、12 个月的泌尿生殖功能。
结果
共前瞻性纳入 89 例计划行 R-TME 和 L-TME 的患者；其中 77 例患者（86.5%）在所有时间点均完成了所有问卷，因此被纳入最终分析。在纳入的患者中，38 例行 R-TME，39 例行 L-TME。两组患者的年龄、BMI、美国麻醉医师协会（ASA）评分、肿瘤部位、新辅助治疗、手术方法、术后病理结果和辅助治疗无显著差异。两组患者术前泌尿生殖功能相似，但 R-TME 组患者术后 6 个月和 12 个月时的 IPSS 明显低于 T-TME 组[（7.82±2.25）比（9.95±3.01），P=0.006；（7.62±2.5）比（9.12±2.64），P=0.012]。R-TME 和 L-TME 术后 3 个月时 IIEF-5 评分均降低（14.87±3.27 比 13.92±3.62，P=0.231），然后逐渐升高；12 个月时，两组患者的 IIEF-5 评分均恢复至基线水平。R-TME 组患者术后 6 个月时的 IIEF-5 评分高于 L-TME 组[（18.55±3.45）比（16.75±3.26），P=0.021]，但 12 个月时两组间无显著差异[（21.22±3.06）比（19.95±3.03），P=0.071]。
结论
与腹腔镜 TME 相比，机器人 TME 方法可更快地恢复男性泌尿生殖功能。
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