Geitenbeek Ritch T J, Genders Charlotte M S, Taoum Christophe, Duhoky Rauand, Burghgraef Thijs A, Fleming Christina A, Cotte Eddy, Dubois Anne, Rullier Eric, Denost Quentin, Khan Jim S, Hompes Roel, Rouanet Philippe, Consten Esther C J
Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands.
Cancers (Basel). 2025 Apr 9;17(8):1268. doi: 10.3390/cancers17081268.
Robot-assisted total mesorectal excision has been proposed as an alternative to laparoscopic TME for rectal cancer. However, its short-term outcomes and long-term oncological efficacy remain debated, especially in Western populations. This study evaluates the short-term clinical and long-term oncological outcomes of robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres.
This multicentre, international, retrospective cohort study included 1390 patients from the EUREKA collaborative dataset who underwent robot-assisted total mesorectal excision for rectal cancer between January 2013 and January 2022. All surgeries were performed by expert surgeons beyond the learning curve. Data were analysed for patient demographics, perioperative outcomes, pathological findings, and three-year survival metrics. Kaplan-Meier analysis was used to evaluate overall and disease-free survival.
Of 1390 patients, 60.6% underwent restorative low anterior resection. Conversion to open surgery occurred in 3.7%, and postoperative complications were reported in 28.7%. Anastomotic leakage occurred in 14.7% of patients who underwent restorative low anterior resection. The median operative time was 223 min. R0 resection was achieved in 94.7%, and circumferential resection margin positivity was 5.5%. Three-year overall survival was 90.1%, disease-free survival was 88.6%, and local recurrence was 2.9%.
Robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres is safe, with low conversion rates, acceptable complication rates, and favourable oncological outcomes. These findings underscore the potential of robot-assisted total mesorectal excision as a standard approach for rectal cancer in specialised settings.
机器人辅助全直肠系膜切除术已被提议作为直肠癌腹腔镜全直肠系膜切除术的替代方案。然而，其短期疗效和长期肿瘤学效果仍存在争议，尤其是在西方人群中。本研究评估了欧洲大型中心经验丰富的外科医生进行的机器人辅助全直肠系膜切除术的短期临床和长期肿瘤学结果。
这项多中心、国际性、回顾性队列研究纳入了来自EUREKA协作数据集的1390例患者，这些患者在2013年1月至2022年1月期间接受了机器人辅助全直肠系膜切除术治疗直肠癌。所有手术均由超出学习曲线的专家外科医生进行。分析了患者的人口统计学数据、围手术期结果、病理发现和三年生存指标。采用Kaplan-Meier分析评估总生存率和无病生存率。
1390例患者中，60.6%接受了低位前切除术。中转开腹手术的发生率为3.7%，术后并发症发生率为28.7%。接受低位前切除术的患者中，吻合口漏发生率为14.7%。中位手术时间为223分钟。R0切除率为94.7%，环周切缘阳性率为5.5%。三年总生存率为90.1%，无病生存率为88.6%，局部复发率为2.9%。
在欧洲大型中心，经验丰富的外科医生进行的机器人辅助全直肠系膜切除术是安全的，中转率低，并发症发生率可接受，肿瘤学效果良好。这些发现强调了机器人辅助全直肠系膜切除术在特定环境下作为直肠癌标准治疗方法的潜力。
