Takamizawa Yasuyuki, Tsukamoto Shunsuke, Kato Takeharu, Nagata Hiroshi, Moritani Konosuke, Kanemitsu Yukihide
Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Surg Endosc. 2025 Jan;39(1):184-193. doi: 10.1007/s00464-024-11374-w. Epub 2024 Nov 1.
The relative benefits of robotic surgery and laparoscopic surgery are controversial in rectal cancer. This study compared the short- and long-term outcomes of robotic surgery with those of laparoscopic surgery in patients with rectal cancer using propensity score analysis.
This study analyzed consecutive patients who underwent minimally invasive surgery for stage I-III rectal cancer between April 2014 and October 2020. After propensity score matching (PSM), short-term outcomes, relapse-free survival, and overall survival were compared between the robotic surgery (RS) group and the laparoscopic surgery (LS) group.
During the study period, 251 patients underwent laparoscopic surgery and 193 underwent robotic surgery. PSM resulted in 160 matched pairs (After PSM, the percentages of patients with stage I, II, and III disease were respectively 56%, 19%, and 24% in the LS group and 49%, 23%, and 28% in the RS group (P = 0.462). Median operation time was 239 min in the LS group and 284 min in the RS group (P = 0.001). The C-reactive protein level on postoperative day 3 was significantly lower in the RS group (4.63 mg/mL vs. 5.86 mg/mL, P = 0.013). Postoperative complications, including ileus and Clavien-Dindo grade II or higher complications, were 6% vs. 1% (P = 0.006) and 21% vs. 12% (P = 0.024) in the LS and RS groups, respectively. The 5-year relapse-free survival rate was 88.5% in the LS group and 90.5% in the RS group (P = 0.525); the respective 5-year overall survival rates were 97.3 and 93.8% (P = 0.283). The 5-year cumulative local and distant recurrence rates were 3.3% vs. 3.3% (P = 0.665) and 9.7% vs. 7.7% (P = 0.464) in the LS and RS groups, respectively CONCLUSION: Robotic surgery can be a feasible treatment modality for rectal cancer, with lower frequencies of postoperative ileus and Clavien-Dindo grade II or higher complications than laparoscopic surgery and no difference in long-term outcomes.
在直肠癌治疗中，机器人手术和腹腔镜手术的相对益处存在争议。本研究采用倾向评分分析比较了直肠癌患者机器人手术与腹腔镜手术的短期和长期疗效。
本研究分析了2014年4月至2020年10月期间连续接受I - III期直肠癌微创手术的患者。在倾向评分匹配（PSM）后，比较机器人手术（RS）组和腹腔镜手术（LS）组的短期疗效、无复发生存率和总生存率。
在研究期间，251例患者接受了腹腔镜手术，193例接受了机器人手术。PSM产生了160对匹配病例（PSM后，LS组中I期、II期和III期疾病患者的百分比分别为56%、19%和24%，RS组分别为49%、23%和28%（P = 0.462）。LS组的中位手术时间为239分钟，RS组为284分钟（P = 0.001）。RS组术后第3天的C反应蛋白水平显著较低（4.63mg/mL对5.86mg/mL，P = 0.013）。LS组和RS组术后并发症，包括肠梗阻和Clavien-Dindo II级或更高等级并发症，分别为6%对1%（P = 0.006）和21%对12%（P = 0.024）。LS组的5年无复发生存率为88.5%，RS组为90.5%（P = 0.525）；各自的5年总生存率分别为97.3%和93.8%（P = 0.283）。LS组和RS组的5年累积局部和远处复发率分别为3.3%对3.3%（P = 0.665）和9.7%对7.7%（P = 0.464）。结论：机器人手术对于直肠癌可能是一种可行的治疗方式，与腹腔镜手术相比，术后肠梗阻和Clavien-Dindo II级或更高等级并发症的发生率较低，且长期疗效无差异。
