机器人辅助与腹腔镜全直肠系膜切除术治疗直肠癌的十年比较（短期RESOLUTION研究）

Ten years of robot-assisted versus laparoscopic total mesorectal excision for rectal cancer (short-term RESOLUTION).

作者信息

Duhoky Rauand, Geitenbeek Ritch T J, Niccolò Piozzi Guglielmo, Burghgraef Thijs A, Fleming Christina A, Masum Shamsul, Hopgood Adrian, Rockall Timothy, Denost Quentin, Taoum Christophe, Hompes Roel, Briggs Jim, Consten Esther C J, Khan Jim S

机构信息

Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom.

School of Computing, University of Portsmouth, Portsmouth, United Kingdom.

出版信息

J Natl Cancer Inst. 2025 Aug 1;117(8):1614-1626. doi: 10.1093/jnci/djaf084.

DOI:10.1093/jnci/djaf084

PMID:40221865

Abstract

BACKGROUND

Total mesorectal excision is the gold standard for rectal cancer surgery, with laparoscopic and robot-assisted approaches commonly employed. While robot-assisted surgery may offer technical advantages, there is limited evidence comparing short-term outcomes of laparoscopic and robot-assisted techniques, particularly in Western European populations. This study aimed to assess the short-term outcomes of laparoscopic vs robot-assisted total mesorectal excision for rectal cancer.

METHODS

This multicenter, international, retrospective cohort study included 1749 patients who underwent laparoscopic or robot-assisted total mesorectal excision from January 2014 to January 2024. Inverse probability of treatment weighting was applied to minimize confounding. Primary outcomes were length of stay, operative time, and conversion rates. Secondary outcomes included complications and pathological outcomes within 90 days, and readmissions and reinterventions within 30 days.

RESULTS

The final cohort included 680.9 laparoscopic and 1057.5 robot-assisted cases after weighting. Robot-assisted surgery showed lower conversion rates (6.1% vs 3.5%, P = .025), higher rates of primary anastomosis (80.1% vs 92.1%, P < .001), and fewer stoma formations (78.4% vs 63.7%, P < .001). Pathological outcomes indicated a higher rate of complete mesorectal excision in the robot-assisted group (77.2% vs 86.0%, P < .001), though these data were not available for all centers. Operative time was longer in the robot-assisted cohort (181.0 vs 220.0 minutes, P < .001), but no significant differences were observed in postoperative complications, length of stay, anastomotic leakage, or 30-day reintervention rates.

CONCLUSION

Robot-assisted surgery low anterior resection demonstrated improved short-term outcomes with lower conversion rates, higher rates of complete mesorectal excision, and higher restorative procedure rates, which may influence longer term oncological and patient quality of life outcomes.

TRIAL REGISTRATION

https://www.isrctn.com/ISRCTN75281193.

摘要

背景

全直肠系膜切除术是直肠癌手术的金标准，常用的手术方式有腹腔镜手术和机器人辅助手术。虽然机器人辅助手术可能具有技术优势，但比较腹腔镜手术和机器人辅助手术短期疗效的证据有限，尤其是在西欧人群中。本研究旨在评估腹腔镜与机器人辅助全直肠系膜切除术治疗直肠癌的短期疗效。

方法

这项多中心、国际性、回顾性队列研究纳入了2014年1月至2024年1月期间接受腹腔镜或机器人辅助全直肠系膜切除术的1749例患者。采用治疗权重的逆概率法以尽量减少混杂因素。主要结局指标为住院时间、手术时间和中转率。次要结局指标包括90天内的并发症和病理结局，以及30天内的再入院和再次干预情况。

结果

加权后最终队列包括680.9例腹腔镜手术病例和1057.5例机器人辅助手术病例。机器人辅助手术的中转率较低（6.1%对3.5%，P = 0.025），一期吻合率较高（80.1%对92.1%，P < 0.001），造口形成较少（78.4%对63.7%，P < 0.001）。病理结局显示机器人辅助组的全直肠系膜完整切除率较高（77.2%对86.0%，P < 0.001），不过并非所有中心都有这些数据。机器人辅助队列的手术时间较长（181.0对220.0分钟，P < 0.001），但术后并发症、住院时间、吻合口漏或30天再次干预率方面未观察到显著差异。