Tokunaga Takuya, Kashihara Hideya, Yoshikawa Kozo, Nakao Toshihiro, Nishi Masaaki, Takasu Chie, Wada Yuma, Yoshimoto Toshiaki, Shimada Mitsuo
Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
Surg Endosc. 2024 Apr;38(4):2070-2077. doi: 10.1007/s00464-024-10730-0. Epub 2024 Mar 4.
Lateral lymph node metastases are a major cause of local recurrence after surgery for advanced low rectal cancer. Lateral lymph node dissection (LLND) may reduce the risk of local recurrence in patients with suspected lateral lymph node metastasis. Recent reports have shown that robotic-assisted LLND can help to reduce the postoperative complication rate, such as urinary disturbance. Furthermore, with the advent of transanal total mesorectal excision, a novel LLND procedure that combines a transabdominal approach with a transanal approach has been reported. This study aimed to clarify the safety and feasibility of robotic-assisted LLND supported by a transanal approach for advanced low rectal cancer.
Thirty-nine patients diagnosed to have low rectal cancer between June 2019 and May 2023 were retrospectively enrolled and divided according to whether they underwent LLND via a robotic-assisted transabdominal approach alone (transabdominal group, n = 19) or in combination with a transanal approach (2team group, n = 20). The patient characteristics and short-term surgical outcomes were compared between the two groups.
The total operation time was significantly shorter in the 2team group than in the transabdominal group (366 min vs. 513 min, P < 0.001), as was the time taken to perform unilateral LLND (64 min vs. 114 min, P < 0.001). Furthermore, there was significantly less intraoperative bleeding in the 2team group (30 mL vs. 80 mL, P = 0.004). There was no significant between-group difference in postoperative complications. The incidence of postoperative urinary disturbance was satisfactory at 5% in both groups.
The operation time for LLND performed by a robotic-assisted transabdominal approach was shortened when supported by a transanal approach. The frequency of postoperative urinary disturbance was low in both groups. Therefore, robotic-assisted abdominal LLND supported by a transanal approach can be considered a promising treatment option for advanced low rectal cancer.
侧方淋巴结转移是晚期低位直肠癌术后局部复发的主要原因。侧方淋巴结清扫术（LLND）可能降低疑似侧方淋巴结转移患者的局部复发风险。最近的报告显示，机器人辅助LLND有助于降低术后并发症发生率，如尿路功能障碍。此外，随着经肛门全直肠系膜切除术的出现，一种将经腹途径与经肛门途径相结合的新型LLND手术已见报道。本研究旨在阐明经肛门途径辅助的机器人辅助LLND治疗晚期低位直肠癌的安全性和可行性。
回顾性纳入2019年6月至2023年5月期间诊断为低位直肠癌的39例患者，并根据他们是单独通过机器人辅助经腹途径进行LLND（经腹组，n = 19）还是联合经肛门途径进行LLND（双途径组，n = 20）进行分组。比较两组患者的特征和短期手术结果。
双途径组的总手术时间显著短于经腹组（366分钟对513分钟，P < 0.001），单侧LLND的手术时间也是如此（64分钟对114分钟，P < 0.001）。此外，双途径组的术中出血量显著更少（30毫升对80毫升，P = 0.004）。术后并发症在组间无显著差异。两组术后尿路功能障碍的发生率均为5%，令人满意。
经肛门途径辅助时，机器人辅助经腹途径进行LLND的手术时间缩短。两组术后尿路功能障碍的发生率均较低。因此，经肛门途径辅助的机器人辅助腹部LLND可被认为是晚期低位直肠癌一种有前景的治疗选择。
