Izukawa Shota, Numata Masakatsu, Fukuda Toshiyuki, Harada Tatsunosuke, Atsumi Yosuke, Kazama Keisuke, Sawazaki Sho, Suzuki Shinsuke, Godai Teni, Higuchi Akio, Tamagawa Hiroshi, Suwa Yusuke, Watanabe Jun, Sato Tsutomu, Saito Aya
Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan.
Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0004, Japan.
Surg Today. 2025 Sep 2. doi: 10.1007/s00595-025-03113-y.
One of the challenges in performing surgery on obese patients with rectal cancer is the prolonged operation time. This study investigates whether or not this issue can be overcome through the surgeon's learning curve as they become proficient in robotic surgery.
A retrospective review of 396 consecutive robotic procedures. The cases were divided into a learning phase (LP) group (first 20 cases) and a stabilized phase (SP) group (from case 21 onward). Patients were divided into obese (BMI ≥ 25 kg/m) and non-obese groups using 1:1 propensity score matching. This resulted in 130 and 72 patients in the LP and SP groups, respectively. The primary endpoint of this study was operation time.
In the LP group, obese patients had significantly longer operative times (329 min vs. 289 min) and greater blood loss (10 g [0-50] vs. 10 g [0-12]) than non-obese patients. In the SP group, the perioperative outcomes, including operation time, were similar between the two patient groups.
This study suggests that during the early phase of the learning curve, operation time may be prolonged in obese patients. However, once the learning curve stabilizes, the issue of prolonged operative time can be overcome.
对肥胖直肠癌患者进行手术面临的挑战之一是手术时间延长。本研究调查随着外科医生在机器人手术方面变得熟练，这个问题是否能通过他们的学习曲线得到克服。
对396例连续的机器人手术进行回顾性分析。病例被分为学习阶段（LP）组（前20例）和稳定阶段（SP）组（从第21例起）。使用1:1倾向评分匹配将患者分为肥胖（BMI≥25kg/m²）和非肥胖组。这使得LP组和SP组分别有130例和72例患者。本研究的主要终点是手术时间。
在LP组中，肥胖患者的手术时间显著长于非肥胖患者（分别为329分钟和289分钟），失血量也更多（分别为10克[0 - 50]和10克[0 - 12]）。在SP组中，两组患者的围手术期结果，包括手术时间，相似。
本研究表明，在学习曲线的早期阶段，肥胖患者的手术时间可能会延长。然而，一旦学习曲线稳定，手术时间延长的问题可以得到克服。
