Grupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain.
Vall d´Hebron University Hospital, Barcelona, Spain.
Br J Surg. 2023 Aug 11;110(9):1153-1160. doi: 10.1093/bjs/znad077.
The impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours.
This was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy-absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy.
Some 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures.
No difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery.
吻合方法和微创手术技术对右半结肠切除术的手术和临床结果的影响尚不确定。MIRCAST 研究的目的是比较在良性或恶性肿瘤的右半结肠切除术中，分别使用腹腔镜或机器人辅助手术进行的腔内吻合（ICA）和腔外吻合（ECA）。
这是一项国际性、多中心、前瞻性、观察性、监测、非随机、平行、四队列研究（腹腔镜 ECA；腹腔镜 ICA；机器人辅助 ECA；机器人辅助 ICA）。来自欧洲 12 个国家的 59 家医院的高容量外科医生（每年至少进行 30 例微创右结肠切除术）在 3 年内治疗了患者。主要复合终点是 30 天的成功，通过两种疗效指标来定义——术后 30 天内无手术伤口感染和任何主要并发症。次要结局包括：总体并发症、转化率、手术持续时间和淋巴结采集数量。倾向评分分析用于比较 ICA 与 ECA、机器人辅助手术与腹腔镜手术。
在意向治疗分析中，共有 1320 例患者纳入研究（腹腔镜 ECA 组 555 例，腹腔镜 ICA 组 356 例，机器人辅助 ECA 组 88 例，机器人辅助 ICA 组 321 例）。在手术后 30 天，各队列之间的主要复合终点没有差异（ECA 组和 ICA 组分别为 7.2%和 7.6%，腹腔镜组和机器人辅助组分别为 6.6%和 7.8%）。ICA 后观察到总体并发症发生率较低，特别是机器人辅助手术后肠麻痹、恶心和呕吐的发生率较低。
在腔外吻合与腔内吻合或腹腔镜与机器人辅助手术之间，未发现手术伤口感染和严重术后并发症的综合结局存在差异。
