机器人右半结肠切除术与腹腔镜右半结肠切除术治疗右半结肠癌的对比研究。
Robotic right colectomy versus laparoscopic right colectomy in patients with right colon cancer: a comparative study.
机构信息
Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
BMC Surg. 2024 Oct 25;24(1):332. doi: 10.1186/s12893-024-02593-y.
BACKGROUND
The study aimed to compare the clinical outcomes of robotic right colectomy (RRC) versus laparoscopic right colectomy (LRC) in patients diagnosed with right colon cancer, given the increasing adoption of robotic surgical techniques and their potential benefits in oncologic surgery.
METHODS
This retrospective comparative study included patients who underwent right colectomy at Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, between January 2019 and May 2022. The primary outcomes measured were the number of lymph nodes harvested. Key secondary outcomes included the operation time, intraoperative blood loss, postoperative complications, hospitalization costs, overall survival (OS), and disease-free survival (DFS). Data were analyzed using multivariable Cox proportional hazards regression to adjust for potential confounders.
RESULTS
A total of 225 patients (aged 65.23 ± 11.45, 108 males) with right colon cancer were included, with 100 (44.4%) patients underwent RRC. Patients who underwent RRC had significantly more lymph nodes harvested (27.69 ± 12.59 vs. 24.43 ± 9.42, P = 0.028), and incurred higher total hospitalization costs compared to those with LRC (9.68 ± 7.12 vs. 5.28 ± 1.23 ten-thousand-yuan, P < 0.001). The OS and DFS were comparable between RRC and LRC (both P > 0.05) within a median follow-up of 27 (range, 9-44) months. Multivariable cox proportional hazards regression showed that patients underwent RRC had significantly higher risk for all-cause death compared with those underwent LRC [hazards ratio (HR) = 2.303, 95% confidence intervals (CI): 1.625-3.265, P < 0.001].
CONCLUSION
Patients underwent RRC seemed to have significantly more numbers of lymph nodes harvested and higher risk for all-cause death and higher hospitalization costs compared with those underwent LRC. These findings suggest a need for careful consideration of the benefits and risks associated with robotic versus laparoscopic right colectomy in clinical practice.
TRIAL REGISTRATION
Not applicable.
背景
本研究旨在比较机器人右半结肠切除术（RRC）与腹腔镜右半结肠切除术（LRC）在右半结肠癌患者中的临床疗效，鉴于机器人手术技术的应用日益广泛及其在肿瘤外科中的潜在优势。
方法
本回顾性对比研究纳入 2019 年 1 月至 2022 年 5 月在浙江大学医学院附属邵逸夫医院接受右半结肠切除术的患者。主要观察终点为淋巴结清扫数量。关键次要观察终点包括手术时间、术中出血量、术后并发症、住院费用、总生存期（OS）和无病生存期（DFS）。采用多变量 Cox 比例风险回归分析调整潜在混杂因素。
结果
共纳入 225 例右半结肠癌患者（年龄 65.23±11.45 岁，男性 108 例），其中 100 例行 RRC。RRC 组患者的淋巴结清扫数量明显更多（27.69±12.59 枚 vs. 24.43±9.42 枚，P=0.028），且总住院费用明显高于 LRC 组（9.68±7.12 万元 vs. 5.28±1.23 万元，P<0.001）。在中位随访 27 个月（范围 9-44 个月）内，RRC 和 LRC 组患者的 OS 和 DFS 无显著差异（均 P>0.05）。多变量 Cox 比例风险回归分析显示，与 LRC 相比，RRC 组患者的全因死亡风险显著升高[风险比（HR）=2.303，95%置信区间（CI）：1.625-3.265，P<0.001]。
结论
与 LRC 相比，RRC 组患者的淋巴结清扫数量更多，全因死亡风险及住院费用更高。这些发现提示在临床实践中需要仔细权衡机器人与腹腔镜右半结肠切除术的获益与风险。
试验注册
不适用。
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