Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Colorectal Dis. 2022 Nov;24(11):1318-1324. doi: 10.1111/codi.16212. Epub 2022 Jun 27.
This study evaluates the relationship of tumour and anatomical features with operative difficulty in robotic low anterior resection performed by four experienced surgeons in a high-volume colorectal cancer practice.
Data from 382 patients who underwent robotic low anterior resection by four expert surgeons between January 2016 and June 2019 were included in the analysis. Operating time was used as a measure of operative difficulty. Univariate and multivariate mixed models were used to identify associations between baseline characteristics and operating time, with surgeon as a random effect, thereby controlling for variability in surgeon speed and proficiency. In an exploratory analysis, operative difficulty was defined as conversion to laparotomy, a positive margin or an incomplete mesorectum.
Median operating time was 4.28 h (range 1.95-11.33 h) but varied by surgeon from 3.45 h (1.95-6.10 h) to 5.93 h (3.33-11.33 h) (P < 0.001). Predictors of longer operating time in multivariate analysis were male sex, higher body mass index, neoadjuvant radiotherapy, low tumour height, greater sacral height and larger mesorectal area at the S5 vertebral level. Conversion occurred in two cases (0.5%), and incomplete mesorectum and positive margins were found in nine (2.4%) and 19 (5.0%) patients, respectively. Neoadjuvant radiotherapy and larger pelvic outlet were the only characteristics associated with the exploratory measure of difficulty.
Predicting operative difficulty based on easy to identify, preoperative radiological and clinical variables is feasible in robotic anterior resection.
本研究评估了肿瘤和解剖特征与四位经验丰富的外科医生在高容量结直肠癌实践中进行机器人低位前切除术的手术难度之间的关系。
分析了 2016 年 1 月至 2019 年 6 月期间四位专家外科医生进行的 382 例机器人低位前切除术患者的数据。手术时间用作衡量手术难度的指标。使用单变量和多变量混合模型来确定基线特征与手术时间之间的关联，其中外科医生为随机效应，从而控制外科医生速度和熟练程度的变异性。在探索性分析中，手术难度定义为转为剖腹手术、阳性边缘或不完全直肠系膜。
中位手术时间为 4.28 小时（范围 1.95-11.33 小时），但外科医生之间的手术时间差异很大，从 3.45 小时（1.95-6.10 小时）到 5.93 小时（3.33-11.33 小时）（P<0.001）。多变量分析中，手术时间较长的预测因素为男性、较高的体重指数、新辅助放疗、低位肿瘤高度、较大的骶骨高度和 S5 椎骨水平较大的直肠系膜区域。有两例（0.5%）发生中转开腹，9 例（2.4%）和 19 例（5.0%）患者发现不完全直肠系膜和阳性切缘。新辅助放疗和较大的骨盆出口是与探索性困难测量唯一相关的特征。
根据易于识别的术前影像学和临床变量预测机器人前切除术的手术难度是可行的。
