Department of Surgery, College of Medicine, Central Michigan University, Mt Pleasant, MI, USA.
Surg Innov. 2023 Apr;30(2):193-200. doi: 10.1177/15533506221125323. Epub 2022 Sep 7.
We examined the perioperative outcomes of patients undergoing open, laparoscopic, or robotic colectomy for T4b colon cancer, as well as the clinical factors associated with conversion to an open approach and its consequences on perioperative and oncologic outcomes.
The National Cancer Database was queried for patients undergoing colectomy for cT4b colon cancer (2010-2016). Patients undergoing laparoscopic or robotic colectomy were matched using Propensity-Score analysis. Factors associated with conversion to an open approach were assessed using Logistic-regression multivariable-analysis (MVA).
Colectomy for cT4b colon cancer was performed in 9030 patients (open: n = 6,543, robotic: n = 157, laparoscopic: n = 2330). In the propensity-matched groups, robotic approach had lower rate of conversion (12% vs 37%, < .001), shorter hospital stays (5 vs 7-days, = .02), and similar overall-survival (5-yr: 49% vs 39%, = .16), compared to laparoscopic approach. Conversion to an open approach was noted in 801(32%) of the patients undergoing minimally invasive surgical colectomy (robotic n = 23(15%), laparoscopic n = 778(33%). Factors associated with lower rate of conversion on multivariable-analysis included recent year of surgery (95% CI: 0.88-.97), robotic approach (95% CI: 0.22-.56), and surgeries performed in Academic hospitals (95% CI: 0.65-.96). Conversion to an open approach was associated with higher rate of positive parenchymal margin (31% vs 25%, = .001), higher rate of 30-day readmission (12% vs 9.5%, = .04), and similar overall survival (5-yr: 32% vs 35%, = .19), compared to those who had no conversion.
At the National level, patients undergoing colectomy for T4b colon cancer via a robotic approach had more favorable perioperative outcomes compared to laparoscopic approach. Conversion to an open approach did not compromise long term survival, despite being associated with higher rate of positive margins and readmissions rate.
我们研究了接受开腹、腹腔镜或机器人结肠切除术治疗 T4b 结肠癌患者的围手术期结果，以及与转为开腹手术相关的临床因素及其对围手术期和肿瘤学结果的影响。
从国家癌症数据库中检索 2010 年至 2016 年接受 T4b 结肠癌结肠切除术的患者。使用倾向评分分析对接受腹腔镜或机器人结肠切除术的患者进行匹配。使用多变量逻辑回归分析（MVA）评估与转为开腹手术相关的因素。
共对 9030 例 T4b 结肠癌患者进行了结肠切除术（开腹：n = 6543，机器人：n = 157，腹腔镜：n = 2330）。在倾向匹配组中，机器人手术的中转率较低（12%比 37%， <.001），住院时间较短（5 天比 7 天， =.02），总体生存率相似（5 年：49%比 39%， =.16），与腹腔镜手术相比。在接受微创外科结肠切除术的 801 例（32%）患者中发现了中转（机器人 n = 23（15%），腹腔镜 n = 778（33%）。多变量分析中与较低的中转率相关的因素包括手术年份较近（95%CI：0.88-.97）、机器人手术（95%CI：0.22-.56）和在学术医院进行的手术（95%CI：0.65-.96）。与无中转相比，中转至开腹手术与更高的阳性切缘率（31%比 25%， =.001）、更高的 30 天再入院率（12%比 9.5%， =.04）和相似的总体生存率（5 年：32%比 35%， =.19）相关。
在全国范围内，与腹腔镜手术相比，接受机器人结肠切除术治疗 T4b 结肠癌的患者具有更有利的围手术期结果。尽管与更高的阳性切缘率和再入院率相关，但转为开腹手术并不影响长期生存率。
