Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
Tech Coloproctol. 2023 Jul;27(7):579-587. doi: 10.1007/s10151-023-02818-x. Epub 2023 May 8.
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.
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。
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