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机器人与腹腔镜微创侧方盆腔淋巴结清扫术治疗中低位进展期直肠癌的回顾性研究:短期疗效比较。

Robotic versus laparoscopic approach for minimally invasive lateral pelvic lymph node dissection of advanced lower rectal cancer: a retrospective study comparing short-term outcomes.

机构信息

Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.

出版信息

Tech Coloproctol. 2023 Jul;27(7):579-587. doi: 10.1007/s10151-023-02818-x. Epub 2023 May 8.


DOI:10.1007/s10151-023-02818-x
PMID:37157049
Abstract

PURPOSE: The importance of lateral pelvic lymph node dissection (LLND) for advanced low rectal cancer is gradually being recognized in Europe and the USA, where some patients were affected by uncontrolled lateral pelvic lymph node (LLNs) metastasis, even after total mesorectal excision (TME) with neoadjuvant chemoradiotherapy (CRT). The purpose of this study was thus to compare robotic LLND (R-LLND) with laparoscopic (L-LLND) to clarify the safety and advantages of R-LLND. METHODS: Sixty patients were included in this single-institution retrospective study between January 2013 and July 2022. We compared the short-term outcomes of 27 patients who underwent R-LLND and 33 patients who underwent L-LLND. RESULTS: En bloc LLND was performed in significantly more patients in the R-LLND than in the L-LLND group (48.1% vs. 15.2%; p = 0.006). The numbers of LLNs on the distal side of the internal iliac region (LN 263D) harvested were significantly higher in the R-LLND than in the L-LLND group (2 [0-9] vs. 1 [0-6]; p = 0.023). The total operative time was significantly longer in the R-LLND than in the L-LLND group (587 [460-876] vs. 544 [398-859]; p = 0.003); however, the LLND time was not significantly different between groups (p = 0.718). Postoperative complications were not significantly different between the two groups. CONCLUSION: The present study clarified the safety and technical feasibility of R-LLND with respect to L-LLND. Our findings suggest that the robotic approach offers a key advantage, allowing significantly more LLNs to be harvested from the distal side of the internal iliac region (LN 263D). Prospective clinical trials examining the oncological superiority of R-LLND are thus necessary in the near future.

摘要

目的:在欧洲和美国,侧方骨盆淋巴结清扫术(LLND)对晚期低位直肠癌的重要性逐渐得到认可,在这些地区,一些患者即使在接受新辅助放化疗(CRT)后行全直肠系膜切除术(TME),仍出现侧方骨盆淋巴结(LLNs)转移未得到控制的情况。因此,本研究旨在比较机器人侧方骨盆淋巴结清扫术(R-LLND)与腹腔镜侧方骨盆淋巴结清扫术(L-LLND),以明确 R-LLND 的安全性和优势。

方法:本研究为单中心回顾性研究,纳入 2013 年 1 月至 2022 年 7 月间 60 例患者。我们比较了 27 例行 R-LLND 患者和 33 例行 L-LLND 患者的短期结果。

结果:R-LLND 组较 L-LLND 组行整块 LLND 的患者比例更高(48.1% vs. 15.2%;p=0.006)。R-LLND 组远端髂内区(LN 263D)的淋巴结数目明显多于 L-LLND 组(2 [0-9] vs. 1 [0-6];p=0.023)。R-LLND 组的总手术时间明显长于 L-LLND 组(587 [460-876] vs. 544 [398-859];p=0.003),但两组 LLND 时间无显著差异(p=0.718)。两组术后并发症无显著差异。

结论:本研究明确了 R-LLND 相对于 L-LLND 的安全性和技术可行性。我们的研究结果表明,机器人方法具有显著优势,能够从髂内区远端(LN 263D)获得更多的淋巴结。因此,在不久的将来,有必要进行前瞻性临床试验,以评估 R-LLND 的肿瘤学优势。

相似文献

[1]
Robotic versus laparoscopic approach for minimally invasive lateral pelvic lymph node dissection of advanced lower rectal cancer: a retrospective study comparing short-term outcomes.

Tech Coloproctol. 2023-7

[2]
[Short-term efficacy of robotic-assisted total mesorectal excision with and without lateral lymph node dissection for mid-low advanced rectal cancer: a propensity score matching analysis].

Zhonghua Wei Chang Wai Ke Za Zhi. 2020-4-25

[3]
Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer treated with preoperative chemoradiotherapy.

Surg Endosc. 2020-3

[4]
Comparison of robotic versus laparoscopic lateral lymph node dissection for advanced lower rectal cancer: a retrospective study at two institutions.

Surg Endosc. 2023-6

[5]
Comparison of the short-term surgical outcomes of lateral lymph node dissection for low rectal cancer using a robotic-assisted transabdominal approach alone or supported by a transanal approach.

Surg Endosc. 2024-4

[6]
Short- and long-term outcomes of laparoscopic versus open lateral lymph node dissection for locally advanced middle/lower rectal cancer using a propensity score-matched analysis.

Surg Endosc. 2021-8

[7]
Systematic review and meta-analysis of long-term oncological outcomes of lateral lymph node dissection for metastatic nodes after neoadjuvant chemoradiotherapy in rectal cancer.

Eur J Surg Oncol. 2022-7

[8]
[Feasibility of a three-sided encapsulation procedure based on fascia anatomy in laparoscopic lateral lymph node dissection for middle and low rectal cancer].

Zhonghua Wei Chang Wai Ke Za Zhi. 2023-10-25

[9]
Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study.

Eur J Surg Oncol. 2021-9

[10]
Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer.

World J Gastroenterol. 2020-6-7

引用本文的文献

[1]
Robotic versus laparoscopic total mesorectal excision for mid-low rectal cancer after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis of oncological, perioperative, and survival-related outcomes.

J Robot Surg. 2025-9-6

[2]
Robotic Beyond Total Mesorectal Excision (bTME) for locally advanced and recurrent anorectal cancer: a systematic review.

J Robot Surg. 2025-7-16

[3]
Learning curve analysis for prophylactic bilateral robot-assisted lateral lymph node dissection for lower rectal cancer: a retrospective study.

Tech Coloproctol. 2025-3-7

[4]
Laparoscopic Versus Robotic Lateral Pelvic Lymph Node Dissection in Locally-Advanced Rectal Cancer: A Cohort Study Comparing Perioperative Morbidity and Short-Term Oncological Outcomes.

Cancer Rep (Hoboken). 2025-3

[5]
Short-term Outcomes of Robotic Lateral Pelvic Lymph Node Dissection for Lower Rectal Cancer.

Fukushima J Med Sci. 2025-4-19

[6]
Robotic-assisted versus laparoscopic-assisted extended mesorectal excision: a comprehensive meta-analysis and systematic review of perioperative and long-term outcomes.

Surg Endosc. 2024-11

[7]
Meta-analysis of the efficacy and safety of robot-assisted comparative laparoscopic surgery in lateral lymph node dissection for rectal cancer.

Surg Endosc. 2024-10

[8]
Comparison of efficacy and safety between robotic-assisted versus laparoscopic surgery for locally advanced mid-low rectal cancer following neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.

Int J Surg. 2025-1-1

[9]
Robotic versus laparoscopic pelvic lateral lymph node dissection in locally advanced rectal cancer: a systemic review and meta-analysis.

Surg Endosc. 2024-7

[10]
Robotic versus laparoscopic total mesorectal excision with lateral lymph node dissection for advanced rectal cancer: A systematic review and meta-analysis.

PLoS One. 2024

本文引用的文献

[1]
Intracorporeal delta-shaped anastomosis without suturing technique in laparoscopic colectomy using a linear stapling device with bioabsorbable polyglycolic acid sheet.

Tech Coloproctol. 2022-7

[2]
Evaluation of the learning curve for robot-assisted rectal surgery using the cumulative sum method.

Surg Endosc. 2022-8

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Outcomes of robot-assisted versus conventional laparoscopic low anterior resection in patients with rectal cancer: propensity-matched analysis of the National Clinical Database in Japan.

BJS Open. 2021-9-6

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On the new (version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer-A commentary.

Cancer Cytopathol. 2021-8

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J Surg Oncol. 2021-9

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Long-term clinical outcomes of total mesorectal excision and selective lateral pelvic lymph node dissection for advanced low rectal cancer: a comparative study of a robotic versus laparoscopic approach.

Tech Coloproctol. 2021-4

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Short-term outcomes of robotic-assisted laparoscopic versus laparoscopic lateral lymph node dissection for advanced lower rectal cancer.

Surg Endosc. 2021-9

[8]
Robotic-assisted surgery may be a useful approach to protect urinary function in the modern era of diverse surgical approaches for rectal cancer.

Surg Endosc. 2021-3

[9]
Predicting lateral pelvic lymph node metastasis based on magnetic resonance imaging before and after neoadjuvant chemotherapy for patients with locally advanced lower rectal cancer.

Surg Today. 2019-10-8

[10]
Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer.

Int J Clin Oncol. 2019-6-15

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