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腹腔镜与机器人右半结肠切除术:欧洲多中心倾向评分匹配回顾性研究。

Right Colectomy with Intracorporeal Anastomosis: A European Multicenter Propensity Score Matching Retrospective Study of Robotic Versus Laparoscopic Procedures.

机构信息

Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, Clichy, France.

University of Paris Est, UPEC, Créteil, France.

出版信息

World J Surg. 2023 Aug;47(8):2039-2051. doi: 10.1007/s00268-023-07031-3. Epub 2023 May 16.

Abstract

BACKGROUND

This study aimed to compare the short- and long-term outcomes of robotic (RRC-IA) versus laparoscopic (LRC-IA) right colectomy with intracorporeal anastomosis using a propensity score matching (PSM) analysis based on a large European multicentric cohort of patients with nonmetastatic right colon cancer.

METHODS

Elective curative-intent RRC-IA and LRC-IA performed between 2014 and 2020 were selected from the MERCY Study Group database. The two PSM-groups were compared for operative and postoperative outcomes, and survival rates.

RESULTS

Initially, 596 patients were selected, including 194 RRC-IA and 402 LRC-IA patients. After PSM, 298 patients (149 per group) were compared. There was no statistically significant difference between RRC-IA and LRC-IA in terms of operative time, intraoperative complication rate, conversion to open surgery, postoperative morbidity (19.5% in RRC-IA vs. 26.8% in LRC-IA; p = 0.17), or 5-yr survival (80.5% for RRC-IA and 74.7% for LRC-IA; p = 0.94). R0 resection was obtained in all patients, and > 12 lymph nodes were harvested in 92.3% of patients, without group-related differences. RRC-IA procedures were associated with a significantly higher use of indocyanine green fluorescence than LRC-IA (36.9% vs. 14.1%; OR: 3.56; 95%CI 2.02-6.29; p < 0.0001).

CONCLUSION

Within the limitation of the present analyses, there is no statistically significant difference between RRC-IA and LRC-IA performed for right colon cancer in terms of short- and long-term outcomes.

摘要

背景

本研究旨在通过基于大型欧洲多中心非转移性右结肠癌患者队列的倾向评分匹配(PSM)分析,比较机器人(RRC-IA)与腹腔镜(LRC-IA)右半结肠切除术联合腔内吻合术的短期和长期结果。

方法

从 MERCY 研究组数据库中选择 2014 年至 2020 年期间进行的选择性根治性 RRC-IA 和 LRC-IA。比较两组患者的手术和术后结果以及生存率。

结果

最初,共选择了 596 例患者,其中 RRC-IA 组 194 例,LRC-IA 组 402 例。经过 PSM 后,对 298 例患者(每组 149 例)进行了比较。RRC-IA 与 LRC-IA 之间在手术时间、术中并发症发生率、中转开腹手术、术后发病率(RRC-IA 组为 19.5%,LRC-IA 组为 26.8%;p=0.17)或 5 年生存率(RRC-IA 组为 80.5%,LRC-IA 组为 74.7%;p=0.94)方面均无统计学差异。所有患者均获得 R0 切除,92.3%的患者采集了>12 枚淋巴结,且两组之间无差异。RRC-IA 组与 LRC-IA 组相比,吲哚菁绿荧光的使用明显更高(36.9%比 14.1%;OR:3.56;95%CI:2.02-6.29;p<0.0001)。

结论

在本分析的限制范围内,RRC-IA 和 LRC-IA 治疗右半结肠癌的短期和长期结果无统计学差异。

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