Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
Int J Colorectal Dis. 2023 Mar 27;38(1):83. doi: 10.1007/s00384-023-04382-0.
The aim of this study is to explore the impact of the approach on conversion in patients undergoing minimally invasive restorative total mesorectal excision within a single unit.
A retrospective cohort study was conducted. Patients with rectal cancer undergoing minimally invasive restorative total mesorectal excision between January 2006 and June 2020 were included. Subjects were classified according to the presence or absence of conversion. Baseline variables and short-term outcomes were compared. Regression analyses were conducted to assess the relationship between the approach and conversion.
During the study period, 318 patients underwent a restorative proctectomy. Of these, 240 met the inclusion criteria. Robotic and laparoscopic approaches were undertaken in 147 (61.3%) and 93 (38.8%) cases, respectively. A transanal approach was utilised in 62 (25.8%) cases (58.1% in combination with a robotic transabdominal approach). Conversion to open surgery occurred in 30 cases (12.5%). Conversion was associated with an increased overall complication rate (P = 0.003), surgical complications (P = 0.009), superficial surgical site infections (P = 0.02) and an increased length of hospital stay (P = 0.006). Robotic and transanal approaches were both associated with decreased conversion rates. The multiple logistic regression analysis, however, showed that only a transanal approach was independently associated with a lower risk of conversion (OR 0.147, 0.023-0.532; P = 0.01), whilst obesity was an independent risk factor for conversion (OR 4.388, 1.852-10.56; P < 0.00).
A transanal component is associated with a reduced conversion rate in minimally invasive restorative total mesorectal excision, regardless of the transabdominal approach utilised. Larger studies will be required to confirm these findings and define which subgroup of patients could benefit from transanal component when a robotic approach is undertaken.
本研究旨在探讨在单一单位内接受微创保肛全直肠系膜切除术的患者中，该方法对转化的影响。
进行了一项回顾性队列研究。纳入 2006 年 1 月至 2020 年 6 月期间接受微创保肛全直肠系膜切除术的直肠腺癌患者。根据是否发生转化对患者进行分类。比较基线变量和短期结局。回归分析评估该方法与转化之间的关系。
在研究期间，有 318 例患者接受了直肠切除术。其中，240 例符合纳入标准。147 例（61.3%）和 93 例（38.8%）分别接受了机器人和腹腔镜手术。62 例（25.8%）患者采用经肛门入路（58.1%与机器人经腹入路联合）。30 例（12.5%）患者中转开腹手术。与开放手术相比，转化组的总并发症发生率（P=0.003）、手术并发症发生率（P=0.009）、浅表手术部位感染发生率（P=0.02）和住院时间延长（P=0.006）均增加。机器人和经肛门入路均与降低转化率相关。然而，多因素逻辑回归分析显示，仅经肛门入路与较低的转化率独立相关（OR 0.147，0.023-0.532；P=0.01），而肥胖是转化的独立危险因素（OR 4.388，1.852-10.56；P<0.00）。
微创保肛全直肠系膜切除术中，无论采用何种经腹入路，经肛门入路均可降低转化率。需要更大规模的研究来证实这些发现，并确定在采用机器人手术时，哪些亚组患者可以从经肛门入路获益。
