Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
Division of Colon and Rectal Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA.
J Robot Surg. 2023 Oct;17(5):2555-2558. doi: 10.1007/s11701-023-01659-y. Epub 2023 Jul 12.
An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Although prior studies have reported that a simultaneous approach to resections in these patients can lead to increased rates of complications, emerging literature shows that minimally invasive surgical (MIS) approaches can mitigate this additional morbidity. This is the first study utilizing a large national database to investigate colorectal and hepatic procedure-specific risks in robotic simultaneous resections for CRC and colorectal liver metastases (CRLM). Utilizing the ACS-NSQIP targeted colectomy, proctectomy, and hepatectomy files, 1,721 patients were identified who underwent simultaneous resections of CRC and CRLM from 2016 to 2021. Of these patients, 345 (20%) underwent resections by an MIS approach, defined as either laparoscopic (n = 266, 78%) or robotic (n = 79, 23%). Patients who underwent robotic resections had lower rates of ileus compared to those who had open surgeries. The robotic group had similar rates of 30-day anastomotic leak, bile leak, hepatic failure, and post-operative invasive hepatic procedures compared to both the open and laparoscopic groups. The rate of conversion to open (8% vs. 22%, p = 0.004) and median LOS (5 vs. 6 days, p = 0.022) was significantly lower for robotic compared to laparoscopic group. This study, which is the largest national cohort of simultaneous CRC and CRLM resections, supports the safety and potential benefits of a robotic approach in these patients.
约 25%的结直肠癌(CRC)患者在诊断时已发生远处转移,最常见的转移部位是肝脏。尽管先前的研究报告称,对这些患者同时进行切除术可能会导致并发症发生率增加,但新的文献表明,微创外科(MIS)方法可以减轻这种额外的发病率。这是第一项利用大型国家数据库研究 CRC 和结直肠肝转移(CRLM)的机器人同时切除术的结直肠和肝特定程序风险的研究。利用 ACS-NSQIP 靶向结直肠切除术、直肠切除术和肝切除术文件,确定了 2016 年至 2021 年间 1721 例同时接受 CRC 和 CRLM 切除术的患者。在这些患者中,345 例(20%)采用 MIS 方法进行了切除术,定义为腹腔镜(n=266,78%)或机器人(n=79,23%)。与接受开放性手术的患者相比,接受机器人切除术的患者肠梗阻发生率较低。机器人组与开放性和腹腔镜组相比,30 天吻合口漏、胆漏、肝衰竭和术后侵袭性肝手术的发生率相似。与腹腔镜组相比,机器人组中转开放性手术(8%比 22%,p=0.004)和中位 LOS(5 比 6 天,p=0.022)的发生率显著降低。这项研究是同时进行 CRC 和 CRLM 切除术的最大国家队列研究,支持机器人方法在这些患者中的安全性和潜在益处。