Laks Shachar, Goldenshluger Michael, Lebedeyev Alexander, Anderson Yasmin, Gruper Ofir, Segev Lior
Faculty of medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
Department of Surgery, Wolfson Medical Center, Holon 5822012, Israel.
Cancers (Basel). 2025 Mar 2;17(5):859. doi: 10.3390/cancers17050859.
Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open approaches. A single referral center in Israel retrospectively reviewed all patients that underwent an elective rectal resection for primary non-metastatic rectal cancer between 2010 and 2020. The cohort was separated into three groups according to the surgical approach: robotic, laparoscopic, or open. The cohort included 526 patients with a median age of 64 years (range 31-89), of whom 103 patients were in the robotic group, 144 in the open group, and 279 patients in the laparoscopic group. The robotic group had significantly more lower rectal tumors (24.3% versus 12.7% and 6%, respectively, < 0.001), more locally advanced tumors (65.6% versus 51.2% and 50.2%, respectively, = 0.004), and higher rates of neoadjuvant radiotherapy (70.9% versus 54.2% and 39.5%, respectively, < 0.001). Conversion to an open laparotomy was more common in the laparoscopy group (23.1% versus 6.8%, respectively, = 0.001). The open approach had higher rates of intraoperative complications (23.2% compared with 10.7% and 13.5% in the robotic and laparoscopic groups, respectively, = 0.011), longer hospital stays (10 days compared with 7 and 8 days, respectively, < 0.001), and higher rates of postoperative complications (76% compared with 68.9% and 59.1%, respectively, = 0.002). The groups were similar in the number of harvested lymph nodes (14) and the incidence of positive resection margins (2.1%). The 5-year overall survival in the robotic group was 92.3% compared with 90.5% and 88.3% in the laparoscopic and open groups, respectively ( = 0.12). The 5-year disease-free survival in the robotic group was 68% compared with 71% and 63%, respectively ( = 0.2). The robotic, laparoscopic, and open approaches had similar histopathological outcomes and long-term oncological outcomes. The open approach was associated with higher rates of perioperative morbidity. These findings suggest that the robotic approach is safe and effective in rectal cancer surgery.
机器人辅助手术是一种具有吸引力且前景广阔的选择，在直肠癌手术中具有独特优势，但最佳手术方式仍存在争议。因此，我们旨在比较机器人辅助手术与腹腔镜辅助手术及开放手术的短期和长期疗效。以色列的一个单一转诊中心回顾性分析了2010年至2020年间所有因原发性非转移性直肠癌接受择期直肠切除术的患者。根据手术方式将队列分为三组：机器人手术组、腹腔镜手术组或开放手术组。该队列包括526例患者，中位年龄为64岁（范围31 - 89岁），其中机器人手术组103例，开放手术组144例，腹腔镜手术组279例。机器人手术组低位直肠癌比例显著更高（分别为24.3%、12.7%和6%，<0.001），局部进展期肿瘤更多（分别为65.6%、51.2%和50.2%，=0.004），新辅助放疗率更高（分别为70.9%、54.2%和39.5%，<0.001）。腹腔镜手术组中转开腹更为常见（分别为23.1%和6.8%，=0.001）。开放手术组术中并发症发生率更高（分别为23.2%，机器人手术组和腹腔镜手术组为10.7%和13.5%，=0.011），住院时间更长（分别为10天，机器人手术组和腹腔镜手术组为7天和8天，<0.001），术后并发症发生率更高（分别为76%，机器人手术组和腹腔镜手术组为68.9%和59.1%，=0.002）。三组在清扫淋巴结数量（14个）和切缘阳性发生率（2.1%）方面相似。机器人手术组5年总生存率为92.3%，腹腔镜手术组和开放手术组分别为90.5%和88.3%（=0.12）。机器人手术组5年无病生存率为68%，腹腔镜手术组和开放手术组分别为71%和63%（=0.2）。机器人手术、腹腔镜手术和开放手术的组织病理学结果和长期肿瘤学结果相似。开放手术围手术期发病率更高。这些发现表明机器人手术在直肠癌手术中是安全有效的。
