Van Eetvelde Ellen, Duhoky Rauand, Piozzi Guglielmo Niccolò, Perez Daniel, Jacobs-Tulleneers-Thevissen Daniel, Khan Jim, Bianchi Paolo Pietro, Ruiz Marcos Gomez
Department of Surgery, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussels, Belgium.
Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Colorectal Dis. 2025 Jan;27(1):e17287. doi: 10.1111/codi.17287.
Complete mesocolic excision (CME) is an oncologically driven technique for treating right colon cancer. While laparoscopic CME is technically demanding and has been associated with more complications, the robotic approach might reduce morbidity. The aim of this study was to assess the safety of stepwise implementation of robotic CME.
A multicentre retrospective analysis of prospectively collected data on robotic right colectomy was performed at five European tertiary centres. Patients were classified for type of surgery: R-RHC (standard right colectomy), R-impCME (learning cases towards robotic CME defined as R-RHC with one but not all the hallmarks of CME) or R-CME (robotic CME). Primary outcomes were overall and severe 30-day complication rates before and after propensity score matching (PSM) analysis.
Five hundred and fifty-one consecutive patients undergoing robotic surgery for (pre)malignant lesions of the right colon between 2010 and 2020 were included: R-RHC (n = 101), R-impCME (n = 135) and R-CME (n = 315). Baseline characteristics differed for American Society of Anesthesiologists score (p = 0.0012) and preoperative diagnosis of adenocarcinoma (p < 0.001). Procedure time increased by surgical complexity (p < 0.001). Vascular event rates did not differ, with no superior mesenteric vein injuries. Conversion, complication and anastomotic leak rates, time to flatus/soft diet and length of stay (LOS) did not differ. While R-RHC was performed for a lower rate of malignancies (p < 0.001), lymph node yield was significantly higher in R-CME (p < 0.001). After PSM, analyses on 186 patients documented no differences in overall and severe 30-day complication rate, conversion rate, LOS or 30-day mortality.
R-CME can be implemented without increasing the overall or 30-day severe complication rate.
完整结肠系膜切除术（CME）是一种基于肿瘤学原理的治疗右结肠癌的技术。虽然腹腔镜CME技术要求高且并发症较多，但机器人辅助手术方法可能会降低发病率。本研究的目的是评估逐步实施机器人辅助CME的安全性。
在欧洲的五个三级中心对前瞻性收集的机器人辅助右半结肠切除术数据进行了多中心回顾性分析。根据手术类型对患者进行分类：R-RHC（标准右半结肠切除术）、R-impCME（向机器人辅助CME过渡的学习病例，定义为具有CME的一个但并非所有特征的R-RHC）或R-CME（机器人辅助CME）。主要结局指标是倾向评分匹配（PSM）分析前后的30天总体和严重并发症发生率。
纳入了2010年至2020年间连续551例接受机器人辅助手术治疗右结肠（前）恶性病变的患者：R-RHC（n = 101）、R-impCME（n = 135）和R-CME（n = 315）。美国麻醉医师协会评分（p = 0.0012）和腺癌术前诊断（p < 0.001）的基线特征存在差异。手术时间随手术复杂性增加（p < 0.001）。血管事件发生率无差异，未发生肠系膜上静脉损伤。中转率、并发症发生率和吻合口漏发生率、排气/软食时间和住院时间（LOS）无差异。虽然R-RHC用于恶性肿瘤的比例较低（p < 0.001），但R-CME的淋巴结收获量显著更高（p < 0.001）。PSM后，对186例患者的分析表明，30天总体和严重并发症发生率、中转率、LOS或30天死亡率无差异。
实施机器人辅助CME不会增加总体或30天严重并发症发生率。
