Katayama Hiroki, Tominaga Tetsuro, Takamura Yuma, Hashimoto Shintaro, Yamashita Mariko, Tei Shoko, Ono Rika, Ishii Mitsutoshi, Hisanaga Makoto, Oishi Kaido, Moriyama Masaaki, Uchida Fumitake, Shiraishi Toshio, Nonaka Takashi
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan.
Surg Today. 2025 Aug 22. doi: 10.1007/s00595-025-03116-9.
The safety and efficacy of robotic surgery in obese patients with rectal cancer remain unclear.
Rectal cancer surgery was performed in 1145 patients at Nagasaki University and seven affiliated institutions between April 2016 and December 2024. Of these, 353 patients who were obese (body mass index, ≥ 25 kg/m) were categorized into three groups based on the surgical approach: robotic surgery (R group, n = 75), laparoscopic surgery (L group, n = 262), and open surgery (O group, n = 15). We compared and analyzed the background factors and postoperative complications between the groups.
The O group showed significantly greater frequencies of poor PS (R group vs. L group vs. O group; 5.3% vs. 8.4% vs. 33.3%, p = 0.002) and postoperative complications (9.3% vs. 18.7% vs. 40.0%, p = 0.011). A multivariate analysis identified that open surgery (odds ratio 6.888, 95% confidence interval 1.846-15.704; p = 0.004), laparoscopic surgery (odds ratio 2.197; 95% confidence interval 1.941-5.162; p = 0.048), and preoperative treatment (odds ratio 2.516; 95% confidence interval 1.284-4.930; p = 0.007) were independent predictors of postoperative complications.
Robotic surgery has shown good postoperative outcomes in obese patients, and it may, therefore, be useful in reducing complications, particularly in patients who have undergone prior treatment.
机器人手术在肥胖直肠癌患者中的安全性和有效性尚不清楚。
2016年4月至2024年12月期间，长崎大学及7家附属医院对1145例患者进行了直肠癌手术。其中，353例肥胖患者（体重指数≥25kg/m²）根据手术方式分为三组：机器人手术组（R组，n = 75）、腹腔镜手术组（L组，n = 262）和开放手术组（O组，n = 15）。我们对三组患者的背景因素和术后并发症进行了比较和分析。
O组患者的PS评分较差（R组 vs. L组 vs. O组；5.3% vs. 8.4% vs. 33.3%，p = 0.002）和术后并发症发生率（9.3% vs. 18.7% vs. 40.0%，p = 0.011）显著更高。多因素分析确定，开放手术（比值比6.888，95%置信区间1.846 - 15.704；p = 0.004）、腹腔镜手术（比值比2.197；95%置信区间1.941 - 5.162；p = 0.048）和术前治疗（比值比2.516；95%置信区间1.284 - 4.930；p = 0.007）是术后并发症的独立预测因素。
机器人手术在肥胖患者中显示出良好的术后效果，因此，它可能有助于减少并发症，特别是在接受过先前治疗的患者中。
