Huscher C G S, Lazzarin Gianni, Marchegiani F, Marks J
Department of Oncologic Surgery, Robotic and New Technology, Cobellis Clinic, Vallo della Lucania, SA, Italy.
General and Mini-Invasive Surgery, Ospedale San Camillo, Via Giovanelli 19, 38122, Trento, Italy.
J Robot Surg. 2023 Apr;17(2):427-434. doi: 10.1007/s11701-022-01435-4. Epub 2022 Jun 26.
The background of this study is to assess the feasibility, clinical utility and safety of intra-corporeal robotic-sewn anastomosis (ICrA) in completely robotic right hemicolectomy (CRH) for adenocarcinoma. A protocol for completely robotic right hemicolectomy (CRH) and intra-corporeal robotic-sewn anastomosis (ICrA), was established at the authors' institution from January 2012 through December 2017. Univariate and multivariable models were constructed to explore the prognostic significance of clinical and surgical findings. Survival and recurrence analysis were performed using standard univariable and multivariable methods. The study population consisted of 123 patients. The median number of examined lymph nodes (ELN) was 25 (range 1-59), the median number of positive lymph nodes (PLN) was 1 (range 0-21). Mean operative time was 240 min (SD 43.56, range 180-360 min), and conversion to open rate was 0%. Anastomotic leaks rate was 1.6%. The median overall survival was 69 months. This pilot series, in which an intra-corporeal robotic-sewn anastomosis (ICrA) was performed during CRH, demonstrated the safety and feasibility of this approach. Compared to the current standard of care at a high-volume center, ICrA was associated with post-operative surgical outcomes similar to those reported in the literature. These results call for further validation in a prospective and controlled setting to be fully incorporated into clinical practice.
本研究的背景是评估体内机器人缝合吻合术（ICrA）在完全机器人辅助右半结肠切除术（CRH）治疗腺癌中的可行性、临床实用性和安全性。从2012年1月至2017年12月，作者所在机构制定了完全机器人辅助右半结肠切除术（CRH）和体内机器人缝合吻合术（ICrA）的方案。构建单变量和多变量模型以探讨临床和手术结果的预后意义。使用标准的单变量和多变量方法进行生存和复发分析。研究人群包括123例患者。检查淋巴结的中位数（ELN）为25个（范围1 - 59个），阳性淋巴结的中位数（PLN）为1个（范围0 - 21个）。平均手术时间为240分钟（标准差43.56，范围180 - 360分钟），中转开腹率为0%。吻合口漏率为1.6%。中位总生存期为69个月。这个在CRH过程中进行体内机器人缝合吻合术（ICrA）的试点系列研究证明了这种方法的安全性和可行性。与高容量中心目前的护理标准相比，ICrA与术后手术结果相关，类似于文献报道的结果。这些结果需要在前瞻性对照研究中进一步验证，以便完全纳入临床实践。
