Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China.
Department of Gastrocolorectal Surgery, The First Hospital of Jilin University, Changchun, China.
Tech Coloproctol. 2023 Jul;27(7):569-578. doi: 10.1007/s10151-023-02788-0. Epub 2023 Apr 4.
Robotic surgery for right-sided colon and rectal cancer has rapidly increased; however, there is limited evidence in the literature of advantages of robotic left colectomy (RLC) for left-sided colon cancer. The purpose of this study was to compare the outcomes of RLC versus laparoscopic left colectomy (LLC) with complete mesocolic excision (CME) for left-sided colon cancer.
Patients who had RLC or LLC with CME for left-sided colon cancer at five hospitals in China between January 2014 and April 2022 were included. A one-to-one propensity score matched analysis was performed to decrease confounding. The primary outcome was postoperative complications occurring within 30 days of surgery. Secondary outcomes were disease-free survival, overall survival and the number of harvested lymph nodes.
A total of 292 patients (187 male; median age 61.0 [20.0-85.0] years) were eligible for this study, and propensity score matching yielded 102 patients in each group. The clinicopathological characteristics were well-matched between groups. The two groups did not differ in estimated blood loss, conversion to open rate, time to first flatus, reoperation rate, or postoperative length of hospital stay (p > 0.05). RLC was associated with a longer operation time (192.9 ± 53.2 vs. 168.9 ± 52.8 min, p = 0.001). The incidence of postoperative complications did not differ between the RLC and LLC groups (18.6% vs. 17.6%, p = 0.856). The total number of lymph nodes harvested in the RLC group was higher than that in the LLC group (15.7 ± 8.3 vs. 12.1 ± 5.9, p < 0.001). There were no significant differences in 3-year and 5-year overall survival or 3-year and 5-year disease-free survival.
Compared to laparoscopic surgery, RLC with CME for left-sided colon cancer was found to be associated with higher numbers of lymph nodes harvested and similar postoperative complications and long-term survival outcomes.
机器人右半结肠癌和直肠癌手术迅速增加；然而，关于机器人左半结肠切除术（RLC）治疗左半结肠癌的优势，文献中的证据有限。本研究旨在比较 RLC 与腹腔镜左半结肠切除术（LLC）联合完整结肠系膜切除术（CME）治疗左半结肠癌的结果。
纳入 2014 年 1 月至 2022 年 4 月期间中国五家医院接受 RLC 或 LLC 联合 CME 治疗左半结肠癌的患者。采用 1:1 倾向评分匹配分析来减少混杂因素。主要结局是术后 30 天内发生的术后并发症。次要结局是无病生存率、总生存率和采集的淋巴结数量。
共有 292 名患者（187 名男性；中位年龄 61.0 [20.0-85.0] 岁）符合本研究条件，经倾向评分匹配后每组各有 102 名患者。两组的临床病理特征匹配良好。两组在估计出血量、中转开腹率、首次排气时间、再手术率和术后住院时间方面无差异（p>0.05）。RLC 手术时间较长（192.9±53.2 比 168.9±52.8 min，p=0.001）。RLC 和 LLC 两组术后并发症发生率无差异（18.6%比 17.6%，p=0.856）。RLC 组采集的淋巴结总数高于 LLC 组（15.7±8.3 比 12.1±5.9，p<0.001）。3 年和 5 年总生存率以及 3 年和 5 年无病生存率无显著差异。
与腹腔镜手术相比，RLC 联合 CME 治疗左半结肠癌与采集更多的淋巴结数量以及相似的术后并发症和长期生存结果相关。
