Shimano Rumi, Kasai Shunsuke, Kagawa Hiroyasu, Shiomi Akio, Manabe Shoichi, Yamaoka Yusuke, Tanaka Yusuke, Igaki Takahiro, Nankaku Akitoshi, Kinugasa Yusuke
Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Gastrointestinal Surgery, Institute of Science Tokyo, Tokyo, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70003. doi: 10.1111/ases.70003.
Robotic total mesorectal excision (TME) with resection of adjacent organs has been increasingly used for locally advanced rectal cancer; however, few studies have focused on robotic TME with partial prostatectomy. Therefore, this study aimed to demonstrate the advantages of robotic TME with partial prostatectomy compared with open surgery for rectal cancer.
This retrospective cohort study examined consecutive patients with rectal cancer who underwent robotic or open TME with partial prostatectomy at a high-volume center in Japan from April 2003 to March 2022. The patients were divided into robotic (n = 14) and open (n = 11) surgery groups. The short- and long-term outcomes of these patients were compared.
More transabdominal partial prostatectomies were performed in the robotic surgery group than in the open surgery group (71.4% vs. 9.1%, p = 0.001). Moreover, sphincter-preserving surgery was performed in 35.7% of patients in the robotic surgery group. The robotic surgery group had shorter operative times (401 min vs. 435 min, p = 0.047), less blood loss (56 mL vs. 484 mL, p < 0.001), lower complication rates (28.6% vs. 72.7%, p = 0.047), and shorter postoperative hospital stays (8 days vs. 18 days, p < 0.001) than the open surgery group. No significant differences were observed in the positive radial margin rate (7.1% vs. 9.1%, p = 1.000) or long-term outcomes between the two groups.
Compared with open surgery, robotic TME with partial prostatectomy facilitates transabdominal partial prostatectomy, resulting in more sphincter-preserving surgeries and better short-term outcomes.
机器人全直肠系膜切除术（TME）联合邻近器官切除已越来越多地用于局部晚期直肠癌；然而，很少有研究关注机器人辅助下的TME联合部分前列腺切除术。因此，本研究旨在证明机器人辅助下的TME联合部分前列腺切除术相较于直肠癌开放手术的优势。
这项回顾性队列研究调查了2003年4月至2022年3月期间在日本一家大型中心接受机器人或开放TME联合部分前列腺切除术的连续性直肠癌患者。患者被分为机器人手术组（n = 14）和开放手术组（n = 11）。比较了这些患者的短期和长期结局。
机器人手术组经腹部分前列腺切除术的实施率高于开放手术组（71.4% 对9.1%，p = 0.001）。此外，机器人手术组35.7%的患者接受了保留括约肌手术。与开放手术组相比，机器人手术组的手术时间更短（401分钟对435分钟，p = 0.047），失血量更少（56毫升对484毫升，p < 0.001）,并发症发生率更低（28.6%对72.7%，p = 0.047），术后住院时间更短（8天对18天，p < 0.001）。两组的环周切缘阳性率（7.1%对9.1%，p = 1.000）或长期结局无显著差异。
与开放手术相比，机器人辅助下的TME联合部分前列腺切除术有利于经腹部分前列腺切除术，从而实现更多的保留括约肌手术并获得更好的短期结局。
