Zhu Heyuan, Zou Jingyu, Pan Hongfeng, Huang Ying, Chi Pan
Union Medical College, Fujian Medical University, No. 1 Xuefu North Road, Fuzhou, Fujian, China.
Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
BMC Surg. 2025 Mar 12;25(1):98. doi: 10.1186/s12893-025-02764-5.
This study aims to assess the short- and long-term outcomes of rectal cancer patients undergoing robotic versus laparoscopic surgery after receiving neo-adjuvant therapy. There is a lack of clarity on this topic, necessitating a comprehensive comparison.
Between January 2017 and December 2021, consecutive patients who underwent laparoscopic and robotic rectal resection at a major public medical center were enrolled. All participants received neo-adjuvant chemoradiotherapy (nCRT) before surgery. The primary objective of this study was to assess the sphincter preservation rate and the rate of conversion to open surgery, using propensity score matching (PSM) analysis. Secondary endpoints included 5-year disease-free survival (DFS), 5-year overall survival (OS), short-term postoperative complications, long-term oncological prognosis, and the occurrence of low anterior resection syndrome (LARS).
A total of 575 patients diagnosed with rectal cancer participated in the cohort study, with 183 individuals undergoing robotic surgery and 392 undergoing laparoscopic surgery. Patients in the robotic group tended to be younger and had higher ypT, cT, and cN stages, lower tumor locations, and higher rates of extramural vascular invasion (EMVI) and circumferential resection margin (CRM) positivity. PSM resulted in 183 patients in the robotic group and 187 in the laparoscopic group. We found a higher sphincter preservation rate in robotic group compared with laparoscopic group (92.9% vs. 86.1%, P = 0.033), with no significant difference in conversion to open surgery(P > 0.05). The robotic group had a higher incidence of postoperative chylous ascites (4.9% vs. 1.1%, P = 0.029) and potentially lower sepsis occurrence (0% vs. 1.6%, P = 0.085). No significant differences were observed in long-term oncological prognosis or 5-year survival rates (P > 0.05). The median survival time for each group was 34 months. Subgroup analysis of 76 rectal cancer patients who underwent intersphincteric resection (ISR) surgery indicated that those who selected robotic surgery had higher cN and cT stages. Furthermore, no statistically significant differences were observed in short-term and long-term clinical outcomes, LARS, OS time, and DFS time between the two surgical modalities. The primary outcomes of interest, specifically the rate of sphincter preservation and the rate of conversion to open laparotomy, showed no significant differences.
Robotic surgery for rectal cancer, following preoperative nCRT, demonstrates comparable technical safety and oncological outcomes to laparoscopic surgery. Further comprehensive studies are needed to to confirm the potential advantages of robotic surgical interventions.
本研究旨在评估接受新辅助治疗后行机器人手术与腹腔镜手术的直肠癌患者的短期和长期结局。关于这一主题尚缺乏明确性，因此有必要进行全面比较。
2017年1月至2021年12月期间，连续纳入在一家大型公立医疗中心接受腹腔镜和机器人直肠切除术的患者。所有参与者在手术前均接受新辅助放化疗（nCRT）。本研究的主要目的是使用倾向评分匹配（PSM）分析评估括约肌保留率和转为开放手术的比率。次要终点包括5年无病生存率（DFS）、5年总生存率（OS）、术后短期并发症、长期肿瘤学预后以及低位前切除综合征（LARS）的发生情况。
共有575例被诊断为直肠癌的患者参与了队列研究，其中183例行机器人手术，392例行腹腔镜手术。机器人手术组的患者往往更年轻，ypT、cT和cN分期更高，肿瘤位置更低，壁外血管侵犯（EMVI）和环周切缘（CRM）阳性率更高。PSM后，机器人手术组有183例患者，腹腔镜手术组有187例患者。我们发现机器人手术组的括约肌保留率高于腹腔镜手术组（92.9%对86.1%，P = 0.033），转为开放手术的比率无显著差异（P > 0.05）。机器人手术组术后乳糜腹水的发生率更高（4.9%对1.1%，P = 0.029），败血症的发生率可能更低（0%对1.6%，P = 0.085）。在长期肿瘤学预后或5年生存率方面未观察到显著差异（P > 0.05）。每组的中位生存时间为34个月。对76例行括约肌间切除术（ISR）的直肠癌患者进行的亚组分析表明，选择机器人手术的患者cN和cT分期更高。此外，两种手术方式在短期和长期临床结局、LARS、OS时间和DFS时间方面未观察到统计学上的显著差异。感兴趣的主要结局，特别是括约肌保留率和转为开放剖腹手术的比率，无显著差异。
术前nCRT后，直肠癌的机器人手术在技术安全性和肿瘤学结局方面与腹腔镜手术相当。需要进一步的综合研究来证实机器人手术干预的潜在优势。
