Pyo Dae Hee, Lee Yoon Suk, Min Byung Soh, Lee Jaeim, Kim Chang Hyun, Oh Heung-Kwon, Yoon Yong Sik, Bae Donghwan, Huh Jung Wook
Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
Int J Surg. 2024 Dec 1;110(12):7630-7635. doi: 10.1097/JS9.0000000000002149.
This study aims to compare outcomes of colorectal cancer surgeries performed using the newly developed articulating laparoscopic instrument, ArtiSential, with those using conventional non-articulating or rigid laparoscopic instruments.
This multicenter, retrospective, matched cohort study enrolled patients with colorectal cancer undergoing laparoscopic surgery in seven tertiary referral hospitals from January 2021 to October 2022. A 1:1 propensity score matching was performed between the articulating (Arti-LAP) and conventional (Rigid-LAP) laparoscopic groups. The primary outcome was the overall incidence of short-term complications.
The study initially comprised 694 and 2008 patients in the Arti-LAP and Rigid-LAP groups, respectively. After matching, each group consisted of 694 patients, with no significant differences in baseline clinical characteristics. The mean operation time was 161±32 min in Arti-LAP and 152±25 min in Rigid-LAP groups (P=0.105). Open conversion rates were 0% (0/694) in Arti-LAP and 1.0% (7/694) in Rigid-LAP groups (P=0.024). Overall morbidity rates were 9.5% (66/694) in Arti-LAP and 12.8% (89/694) in Rigid-LAP (P=0.061), with similar rates of severe morbidities. Specimen quality was acceptable in both groups. Multivariable regression analysis showed that the choice of instrument type (articulating or rigid) was not associated with perioperative morbidity. Despite a short median follow-up period of 19.5 months, no significant difference in disease-free survival was observed between the groups.
Laparoscopic surgery using ArtiSential was performed safely and effectively for patients with colorectal cancer. Articulating laparoscopic instruments may offer an advantage in reducing open conversion rates.
本研究旨在比较使用新开发的关节式腹腔镜器械ArtiSential进行的结直肠癌手术与使用传统非关节式或刚性腹腔镜器械进行的手术的结果。
本多中心、回顾性、匹配队列研究纳入了2021年1月至2022年10月在7家三级转诊医院接受腹腔镜手术的结直肠癌患者。在关节式（Arti-LAP）和传统（Rigid-LAP）腹腔镜组之间进行1:1倾向评分匹配。主要结局是短期并发症的总体发生率。
该研究最初在Arti-LAP组和Rigid-LAP组分别纳入了694例和2008例患者。匹配后，每组各有694例患者，基线临床特征无显著差异。Arti-LAP组的平均手术时间为161±32分钟，Rigid-LAP组为152±25分钟（P=0.105）。Arti-LAP组的开放转换率为0%（0/694），Rigid-LAP组为1.0%（7/694）（P=0.024）。Arti-LAP组的总体发病率为9.5%（66/694），Rigid-LAP组为12.8%（89/694）（P=0.061），严重发病率相似。两组的标本质量均可接受。多变量回归分析表明，器械类型（关节式或刚性）的选择与围手术期发病率无关。尽管中位随访期较短，仅19.5个月，但两组之间无病生存率无显著差异。
使用ArtiSential进行腹腔镜手术对结直肠癌患者安全有效。关节式腹腔镜器械在降低开放转换率方面可能具有优势。
