Horvath Philipp, Steidle Christoph, Yurttas Can, Baur Isabella, Königsrainer Alfred, Königsrainer Ingmar
Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72074 Tübingen, Germany.
Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6807 Feldkirch, Austria.
J Clin Med. 2023 Jul 19;12(14):4765. doi: 10.3390/jcm12144765.
(1) Background: Laparoscopic resection for colon and rectal cancer was introduced in the early 1990s; the aim of this analysis was to show possible advantages of minimal-invasive approaches in rectal cancer surgery. (2) Methods: From 2016 to 2020, all patients undergoing open, laparoscopic or robotic-assisted rectal cancer surgery in Germany were retrospectively analyzed regarding sex distribution, conversion rates and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRGs). (3) Results: In total, 68,112 patients were analyzed, and most commonly, low anterior rectal resections with primary anastomosis ( = 25,824) were performed with an increase of minimal-invasive procedures over the years (open: 51% to 27%; laparoscopic: 47% to 63% and robotic: 2% to 10%). In-hospital mortality rate was 2.95% ( = 2012). In total, 4.61%, 1.77%, 1.14% and 3.95% of patients with open, laparoscopic, robotic and converted-to-open surgery died during hospital stay, respectively (open vs. laparoscopic < 0.0001; open vs. robotic < 0.00001; laparoscopic vs. robotic = 0.001). Conversion rates were significantly more favorable in the robotic compared to the laparoscopic group. (11.94% vs. 2.53%; < 0.0001). (4) Conclusion: Minimal-invasive rectal cancer surgery might have some advantages in terms of a reduced in-hospital mortality, and an improved conversion rate for the robotic approach.
(1) 背景：腹腔镜结肠直肠癌切除术于20世纪90年代初被引入；本分析的目的是展示微创方法在直肠癌手术中的潜在优势。(2) 方法：根据基于诊断相关分组（DRGs）的全国医院计费数据，对2016年至2020年期间在德国接受开放、腹腔镜或机器人辅助直肠癌手术的所有患者的性别分布、中转率和住院死亡率进行回顾性分析。(3) 结果：共分析了68112例患者，最常见的是低位前切除术并一期吻合（=25824例），这些年微创操作有所增加（开放手术：从51%降至27%；腹腔镜手术：从47%增至63%；机器人手术：从2%增至10%）。住院死亡率为2.95%（=2012）。接受开放手术、腹腔镜手术、机器人手术和中转开放手术的患者在住院期间死亡的比例分别为4.61%、1.77%、1.14%和3.95%（开放手术与腹腔镜手术相比P<0.0001；开放手术与机器人手术相比P<0.00001；腹腔镜手术与机器人手术相比P=0.001）。机器人手术组的中转率明显优于腹腔镜手术组（11.94%对2.53%；P<0.0001）。(4) 结论：微创直肠癌手术在降低住院死亡率和提高机器人手术中转率方面可能具有一些优势。
