Fleming C A, Geitenbeek R T J, Duhoky R, Moussion A, Bouazza N, Khan J, Cotte E, Dubois A, Rullier E, Hompes R, Rouanet P, Consten E C J, Denost Q
Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France.
Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
Colorectal Dis. 2025 Aug;27(8):e70188. doi: 10.1111/codi.70188.
Reporting of pelvic sepsis rates following robotic total mesorectal excision (R-TME) for rectal cancer is inconsistent. This IDEAL stage 2b international multicentre study analysed the prevalence of pelvic sepsis rates and associated risk factors following R-TME and generated a risk prediction model for anastomotic leak (AL).
Patients were identified through the EUREKA (Expert DUtch, FREnch and UK robotic rectal cAncer centres) collaborative. Adult patients undergoing R-TME with primary anastomosis for biopsy-proven rectal cancer were considered for inclusion. The primary outcome was to report the prevalence and risk factors associated with pelvic sepsis and anastomotic leak and subsequently to generate a risk prediction model for AL (categorized by ISREC criteria). Receiver operating characteristic (ROC) analysis was performed to confirm the prediction model for significant risk factors for AL (AUC > 0.5). Calibration and discrimination to assess model predictive accuracy were also performed.
A total of 912 patients were analysed. 14% of patients developed pelvic sepsis and 7% an AL. Pelvic sepsis was associated with the following risk factors: male gender [OR 1.650 (95% CI 1.092-2.539, p = 0.020)], administration of NACRT (with the highest prevalence observed following SCRT) [OR 0.650 (95% CI 0.421-0.994, p = 0.049)], increasing duration of surgery [OR 0.997 (95% CI 0.994-0.999, p = 0.040)]. A moderate strength [AUC: 0.613 (95% CI 0.557-0.612)] risk of pelvic sepsis prediction model for robotic TME for rectal cancer was generated. On internal validation, moderate prediction was further maintained [training group AUC 0.610 (95% CI 0.544-0.611), verification group AUC 0.623 (95% CI 0.524-0.622)].
Fourteen per cent of patients will develop pelvic sepsis following robotic TME with primary anastomosis for rectal cancer, and 7% will develop an anastomotic leak. Risk factors associated with pelvic sepsis include male gender, neoadjuvant therapy (SCRT) and longer duration of surgery.
关于机器人全直肠系膜切除术（R-TME）治疗直肠癌后盆腔感染率的报告并不一致。这项IDEAL 2b期国际多中心研究分析了R-TME后盆腔感染率的患病率及相关危险因素，并生成了吻合口漏（AL）的风险预测模型。
通过EUREKA（荷兰、法国和英国机器人直肠癌中心专家）合作组织确定患者。纳入接受R-TME及一期吻合术治疗经活检证实的直肠癌的成年患者。主要结局是报告盆腔感染和吻合口漏的患病率及相关危险因素，随后生成AL的风险预测模型（根据ISREC标准分类）。进行受试者操作特征（ROC）分析以确认AL显著危险因素的预测模型（AUC＞0.5）。还进行了校准和鉴别以评估模型预测准确性。
共分析了912例患者。14%的患者发生盆腔感染，7%发生AL。盆腔感染与以下危险因素相关：男性[比值比（OR）1.650（95%置信区间1.092-2.539，p = 0.020）]、接受新辅助放化疗（NACRT）（同步放化疗后患病率最高）[OR 0.650（95%置信区间0.421-0.994，p = 0.049）]、手术时间延长[OR 0.997（95%置信区间0.994-0.999，p = 0.040）]。生成了一个针对直肠癌机器人TME的盆腔感染中度强度风险预测模型[AUC：0.613（95%置信区间0.557-0.612）]。在内部验证中，中度预测得以进一步维持[训练组AUC 0.610（95%置信区间0.544-0.611），验证组AUC 0.623（95%置信区间0.524-0.622）]。
接受机器人TME及一期吻合术治疗直肠癌的患者中，14%会发生盆腔感染，7%会发生吻合口漏。与盆腔感染相关的危险因素包括男性、新辅助治疗（同步放化疗）和手术时间延长。
