Li Linye, Liu Kuijie, Li Tiegang, Zhou Jiangjiao, Xu Shu, Yu Nanhui, Guo Zhushu, Yao Hongliang
Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Gastrointestinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
Front Oncol. 2023 Mar 17;13:1153751. doi: 10.3389/fonc.2023.1153751. eCollection 2023.
Laparoscopic natural orifice specimen extraction surgery (NOSES) has been widely used in colorectal neoplasms. However, only a few studies have focused on robotic NOSES. This study compared the short-term clinical outcomes and long-term survival outcomes between robotic NOSES and conventional robotic resection (CRR) groups.
From March 2016 to October 2018, a consecutive of 143 patients who underwent robotic sigmoid and rectal resection at the Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, were considered for inclusion in this study. Propensity-score matching (PSM) was conducted to account for differences in the baseline characteristics. After PSM, 39 patients were included in the robotic NOSES group, and 39 patients in the CRR group. The baseline characteristics between the two groups were all balanced and comparable.
Patients in the NOSES group experienced less intraoperative blood loss (p=0.001), lower requirements for additional analgesia (p=0.020), shorter time to first flatus (p=0.010), and a shorter time to first liquid diet (p=0.003) than the CRR group. The 3-year overall survival rates (NOSES: 92.3% vs. CRR: 89.7% p=1.000) and 3-year disease-free survival rates (NOSES: 82.1% vs. CRR: 84.6% p=0.761) between the two groups were comparable.
Robotic natural orifice specimen extraction surgery is a safe and feasible surgery for patients with colorectal neoplasms. Robotic NOSES is associated with better short-term clinical outcomes and similar long-term survival outcomes to conventional robotic resection.
腹腔镜经自然腔道标本取出手术（NOSES）已在结直肠肿瘤中广泛应用。然而，仅有少数研究关注机器人辅助NOSES。本研究比较了机器人辅助NOSES组与传统机器人切除术（CRR）组的短期临床结局和长期生存结局。
2016年3月至2018年10月，中南大学湘雅二医院胃肠外科连续143例行机器人辅助乙状结肠和直肠切除术的患者被纳入本研究。采用倾向得分匹配（PSM）以平衡基线特征差异。PSM后，机器人辅助NOSES组纳入39例患者，CRR组纳入39例患者。两组间的基线特征均达到平衡且具有可比性。
与CRR组相比，NOSES组患者术中失血量更少（p = 0.001），额外镇痛需求更低（p = 0.020），首次排气时间更短（p = 0.010），首次进流食时间更短（p = 0.003）。两组间的3年总生存率（NOSES组：92.3% vs. CRR组：89.7%，p = 1.000）和3年无病生存率（NOSES组：82.1% vs. CRR组：84.6%，p = 0.761）相当。
机器人经自然腔道标本取出手术对结直肠肿瘤患者是一种安全可行的手术方式。机器人辅助NOSES与更好的短期临床结局相关，且长期生存结局与传统机器人切除术相似。
