Houqiong Ju, Ziwen Wan, Chonghan Zhong, Penghui He, Hongxin Yu, Weijie Lu, Dongning Liu, Taiyuan Li
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Laboratory of Digestive Surgery, Nanchang University, Nanchang, China.
Front Surg. 2023 Feb 16;10:1092128. doi: 10.3389/fsurg.2023.1092128. eCollection 2023.
Natural orifice specimen extraction surgery (NOSES), as a new star of minimally invasive techniques, has been increasingly favored and promoted in the field of surgery around the world. Most previous studies were comparative studies of laparoscopic NOSES and conventional laparoscopic surgery. However, there is little research on comparing robotic colorectal cancer NOSES with conventional robotic-assisted colorectal cancer resection surgery.
This study is a retrospective study of propensity score matching (PSM). This study included Ninety-one propensity score-matched pairs of the participant who had undergone robotic colorectal cancer resection surgery at our center between January 2017 and December 2020. The covariates used in the propensity score included gender, age, BMI, ASA score, maximum tumor diameter, the tumor's height from the anal verge, histological differentiation, AJCC stage, T stage, N stage, and history of previous abdominal surgery. The outcome measurement criteria included postoperative complications, inflammatory response, pelvic floor function, anal function, cosmetic outcome, quality of life, disease-free survival (DFS), and overall survival (OS).
The robotic NOSES group had faster recovery time from gastrointestinal function ( = 0.014), shorter abdominal incision length ( < 0.001), less pain ( < 0.001), less additional analgesia required ( < 0.001), and lower postoperative indicators of white blood cell count ( < 0.001) and C-reactive protein content compared to the robotic-assisted resection surgery (RARS) group ( = 0.035). Additionally, the robotic NOSES group had significantly better body imagery ( < 0.001), cosmetic scores ( < 0.001), somatic function ( = 0.003), role function ( = 0.039), emotional function ( = 0.001), social function ( = 0.004), and overall function ( < 0.001) than the RARS group. The two groups demonstrated no significant difference between DFS and OS.
Robotic colorectal cancer NOSES is a safe and feasible minimally invasive procedure and offers shorter abdominal incisions, less pain, less surgical stress response, and better postoperative quality of life. Therefore, this technique can be further promoted for colorectal cancer patients eligible for NOSES.
自然腔道标本取出手术（NOSES）作为微创技术的一颗新星，在全球外科领域越来越受到青睐和推广。以往大多数研究是腹腔镜NOSES与传统腹腔镜手术的对比研究。然而，关于机器人辅助结直肠癌NOSES与传统机器人辅助结直肠癌切除术的比较研究较少。
本研究是一项倾向评分匹配（PSM）的回顾性研究。本研究纳入了2017年1月至2020年12月期间在本中心接受机器人辅助结直肠癌切除术的91对倾向评分匹配的参与者。倾向评分中使用的协变量包括性别、年龄、体重指数、美国麻醉医师协会（ASA）评分、最大肿瘤直径、肿瘤距肛缘高度、组织学分化、美国癌症联合委员会（AJCC）分期、T分期、N分期以及既往腹部手术史。结局测量标准包括术后并发症、炎症反应、盆底功能、肛门功能、美容效果、生活质量、无病生存期（DFS）和总生存期（OS）。
与机器人辅助切除术（RARS）组相比，机器人NOSES组胃肠功能恢复时间更快（P = 0.014），腹部切口长度更短（P < 0.001），疼痛更轻（P < 0.001），所需额外镇痛更少（P < 0.001），术后白细胞计数（P < 0.001）和C反应蛋白含量指标更低（P = 0.035）。此外，机器人NOSES组在身体形象（P < 0.001）、美容评分（P < 0.001）、躯体功能（P = 0.003）、角色功能（P = 0.039）、情感功能（P = 0.001）、社会功能（P = 0.004）和总体功能（P < 0.001）方面明显优于RARS组。两组在DFS和OS方面无显著差异。
机器人辅助结直肠癌NOSES是一种安全可行的微创手术，具有腹部切口短、疼痛轻、手术应激反应小以及术后生活质量更好等优点。因此，对于符合NOSES条件的结直肠癌患者，该技术可进一步推广。
