Park Eun Ji, Noh Gyong Tae, Lee Yong Joon, Park Min Young, Yang Seung Yoon, Han Yoon Dae, Cho Min Soo, Hur Hyuk, Lee Kang Young, Min Byung Soh
Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Division of Colorectal Surgery, Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
Ann Coloproctol. 2024 Dec;40(6):594-601. doi: 10.3393/ac.2024.00171.0024. Epub 2024 Dec 6.
Robot-assisted surgery is readily applied to every type of colorectal surgeries. However, studies showing the safety and feasibility of robotic surgery (RS) have dealt with rectal cancer more than colon cancer. This study aimed to investigate how technical advantages of RS can translate into actual clinical outcomes that represent postoperative systemic response.
This study retrospectively reviewed consecutive cases in a single tertiary medical center in Korea. Patients with primary colon cancer who underwent curative resection between 2006 and 2012 were included. Propensity score matching was done to adjust baseline patient characteristics (age, sex, body mass index, American Society of Anesthesiologists physical status, tumor profile, pathologic stage, operating surgeon, surgery extent) between open surgery (OS), laparoscopic surgery (LS), and RS groups.
After propensity score matching, there were 66 patients in each group for analysis, and there was no significant differences in baseline patient characteristics. Maximal postoperative leukocyte count was lowest in the RS group and highest in the OS group (P=0.021). Similar results were observed for postoperative neutrophil count (P=0.024). Postoperative prognostic nutritional index was highest in the RS group and lowest in the OS group (P<0.001). The time taken to first flatus and soft diet resumption was longest in the OS group and shortest in the RS group (P=0.001 and P<0.001, respectively). Among all groups, other short-term postoperative outcomes such as hospital stay and complications did not show significant difference, and oncological survival results were similar.
Better postoperative inflammatory indices in the RS group may correlate with their faster recovery of bowel motility and diet resumption compared to LS and OS groups.
机器人辅助手术已广泛应用于各类结直肠手术。然而，显示机器人手术（RS）安全性和可行性的研究更多关注直肠癌而非结肠癌。本研究旨在探讨RS的技术优势如何转化为代表术后全身反应的实际临床结果。
本研究回顾性分析了韩国一家三级医疗中心的连续病例。纳入2006年至2012年间接受根治性切除的原发性结肠癌患者。采用倾向评分匹配法调整开放手术（OS）、腹腔镜手术（LS）和RS组之间的基线患者特征（年龄、性别、体重指数、美国麻醉医师协会身体状况、肿瘤特征、病理分期、手术医生、手术范围）。
倾向评分匹配后，每组有66例患者进行分析，基线患者特征无显著差异。RS组术后白细胞计数最高值最低，OS组最高（P = 0.021）。术后中性粒细胞计数也观察到类似结果（P = 0.024）。RS组术后预后营养指数最高，OS组最低（P < 0.001）。OS组首次排气和恢复软食的时间最长，RS组最短（分别为P = 0.001和P < 0.001）。在所有组中，其他术后短期结果如住院时间和并发症无显著差异，肿瘤学生存结果相似。
与LS组和OS组相比，RS组更好的术后炎症指标可能与其更快的肠道蠕动恢复和饮食恢复相关。
