Colorectal Research Unit, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Divison of Colon and Rectal Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA.
J Robot Surg. 2023 Dec;17(6):2929-2936. doi: 10.1007/s11701-023-01725-5. Epub 2023 Oct 14.
Multivisceral robotic surgery may be an alternative to sequential procedures in select patients with colorectal cancer who are diagnosed with synchronous lesions or in those who require additional procedures at the time of resection. The aim of this study was to assess utilization of the robot for multivisceral resections and compare the surgical outcomes of this approach to laparoscopic resections. Adult colorectal surgery patients who underwent a colectomy or proctectomy and a concurrent abdominal surgery procedure in the American College of Surgeons NSQIP database (2016-2021) were included. The primary outcomes were 30-day postoperative overall and serious morbidity. Factors associated with morbidity were assessed using a multivariable logistic regression. Of the 3875 patients who underwent simultaneous multivisceral resections, 397 (10.3%) underwent a robotic approach and 962 (24.8%) a laparoscopic approach. Gynecological procedures (38%) comprised the largest proportion of concurrent procedures followed by hepatic resections (18%). On unadjusted analysis, rates of overall morbidity (25.4% vs. 30.0%) and serious morbidity (12.1% vs 12.0%) did not differ between the robotic and laparoscopic approach groups, respectively. The rate of conversion to open was lower for the robotic compared to laparoscopic approach (9.3% vs. 28.8%, p < 0.001), and length of stay was shorter (4 vs. 5, p < 0.001). On adjusted analysis, there was no significant difference in overall (OR 0.87, 95% CI 0.65-1.16, p = 0.34) or serious morbidity (OR 1.12, 95% CI 0.75-1.65, p = 0.59) between the two approaches even after concurrent procedure risk stratification. Robotic multivisceral resections can be performed with acceptable overall and serious morbidity in select patients with colorectal cancer. Rates of conversion and length of stay may be decreased with a robotic approach, and future research is needed to determine the optimal operative approach in this patient population.
多脏器机器人手术可能是一种替代方法,适用于在诊断为同时性病变的特定结直肠癌患者或在切除时需要额外手术的患者中,采用连续手术。本研究旨在评估机器人在多脏器切除中的应用,并将这种方法与腹腔镜切除的手术结果进行比较。纳入美国外科医师学会 NSQIP 数据库(2016-2021 年)中接受结直肠切除术或直肠切除术和同时性腹部手术的成年结直肠手术患者。主要结局是 30 天术后总体和严重发病率。使用多变量逻辑回归评估与发病率相关的因素。在 3875 例同时进行多脏器切除的患者中,397 例(10.3%)采用机器人方法,962 例(24.8%)采用腹腔镜方法。妇科手术(38%)构成了同时进行的手术中最大的比例,其次是肝切除术(18%)。在未调整的分析中,机器人组和腹腔镜组的总体发病率(25.4%比 30.0%)和严重发病率(12.1%比 12.0%)没有差异。与腹腔镜组相比,机器人组的中转开腹率较低(9.3%比 28.8%,p<0.001),住院时间较短(4 天比 5 天,p<0.001)。在调整分析中,即使在进行同时性手术风险分层后,两种方法之间的总体发病率(OR 0.87,95%CI 0.65-1.16,p=0.34)或严重发病率(OR 1.12,95%CI 0.75-1.65,p=0.59)均无显著差异。机器人多脏器切除术可在选择的结直肠癌患者中安全进行,其总体发病率和严重发病率可接受。采用机器人方法可能会降低转化率和住院时间,需要进一步研究以确定该患者人群的最佳手术方法。