Hanaoka Marie, Kagawa Hiroyasu, Igarashi Ataru, Yoshihara Hiroshi, Yamauchi Shinichi, Tokunaga Masanori, Peng-Lin Lin, Shin Minkyung, Kinugasa Yusuke
Department of Gastrointestinal Surgery Institute of Science Tokyo Tokyo Japan.
Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences The University of Tokyo Tokyo Japan.
Ann Gastroenterol Surg. 2025 Apr 16;9(5):1017-1028. doi: 10.1002/ags3.70024. eCollection 2025 Sep.
Robot-assisted surgery has short-term benefits in rectal cancer surgery; however, its long-term advantages remain unclear. This study compared short- and long-term outcomes of open, laparoscopic, and robot-assisted rectal cancer surgeries using large-scale, database-driven evidence.
Patients (28 711) diagnosed with clinical stages I-III rectal cancer who underwent rectal resection and were registered in the Japanese Medical Data Vision Co. Ltd. database were included. Open rectal resection (ORR), laparoscopic rectal resection (LRR), and robot-assisted rectal resection (RARR) were identified. The primary outcomes were 5-year overall survival (OS) and relapse-free survival (RFS). Secondary outcomes included perioperative outcomes.
After applying overlap weight, the RARR, LRR, and ORR groups had 3635 (15.3%), 17 142 (72.3%), and 2935 (12.4%) patients, respectively. Among the cohort (mean age: 69.5 years), 64.9% were male, and 24.7%, 31.5%, and 43.8% had clinical stages I, II, and III, respectively. The RARR group demonstrated the lowest postoperative complication rate, 30- and 90-day mortality rates, and shortest hospital stay. The RARR group had the highest 5-year OS (95%) and RFS (93%) compared to LRR (OS: 89%, RFS: 86%) and ORR (OS: 81%, RFS: 77%; < 0.001). Multivariable analysis revealed that RARR was significantly associated with improved OS, whereas higher risks were observed for LRR (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 1.69-2.81) and ORR (HR: 3.96, 95% CI: 3.03-5.19).
The RARR group demonstrated superior short- and long-term outcomes than the LRR and ORR groups, indicating robot-assisted surgery as a potential new standard treatment for rectal cancer.
机器人辅助手术在直肠癌手术中具有短期益处；然而，其长期优势仍不明确。本研究使用大规模、基于数据库的证据比较了开放、腹腔镜和机器人辅助直肠癌手术的短期和长期结果。
纳入在日本医疗数据视觉有限公司数据库中登记的、诊断为临床I-III期直肠癌且接受直肠切除术的患者（28711例）。确定开放直肠切除术（ORR）、腹腔镜直肠切除术（LRR）和机器人辅助直肠切除术（RARR）。主要结局为5年总生存率（OS）和无复发生存率（RFS）。次要结局包括围手术期结局。
应用重叠权重后，RARR组、LRR组和ORR组分别有3635例（15.3%）、17142例（72.3%）和2935例（12.4%）患者。在该队列（平均年龄：69.5岁）中，64.9%为男性，分别有24.7%、31.5%和43.8%的患者处于临床I期、II期和III期。RARR组术后并发症发生率、30天和90天死亡率最低，住院时间最短。与LRR组（OS：89%，RFS：86%）和ORR组（OS：81%，RFS：77%；P<0.001）相比，RARR组5年OS（95%）和RFS（93%）最高。多变量分析显示，RARR与OS改善显著相关，而LRR（风险比[HR]：2.18，95%置信区间[CI]：1.69-2.81）和ORR（HR：3.96，95%CI：3.03-5.19）风险更高。
RARR组的短期和长期结局优于LRR组和ORR组，表明机器人辅助手术是直肠癌潜在的新标准治疗方法。
