Comparison of short-term outcomes between robotic-assisted versus laparoscopic total mesorectal excision (TME) for rectal cancer

Wang He

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Comparison of short-term outcomes between robotic-assisted versus laparoscopic total mesorectal excision (TME) for rectal cancer

更新时间：2023-04-16

- Comparison of short-term outcomes between robotic-assisted versus laparoscopic total mesorectal excision (TME) for rectal cancer
- Journal of Chongqing Medical University Vol. 47, Issue 9, Pages: 1089-1094(2022)
- 作者机构：
  
  甘肃中医药大学临床医学院,兰州,730000
- 作者简介：
- 基金信息：
- DOI：
  CLC： R61
- Published：2022，
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Wang He. Comparison of short-term outcomes between robotic-assisted versus laparoscopic total mesorectal excision (TME) for rectal cancer. [J]. Journal of Chongqing Medical University 47(9):1089-1094(2022)
DOI：

Wang He. Comparison of short-term outcomes between robotic-assisted versus laparoscopic total mesorectal excision (TME) for rectal cancer. [J]. Journal of Chongqing Medical University 47(9):1089-1094(2022) DOI：

摘要

目的：比较达芬奇机器人和腹腔镜行直肠癌TME手术的近期临床疗效。方法：回顾性分析2017年1月至2020年1月甘肃省人民医院肛肠科365例行直肠癌TME手术的患者临床资料，根据手术方式不同分为2组，其中机器人组175例，腹腔镜组190例，比较2组术中、术后和随访情况。结果：相比于腹腔镜组，机器人组术中出血量明显较少[（94.8±55.6）mL vs.（127.4±42.1）mL，t=-2.739，P=0.007]；术后排气时间较短[（60.3±11.9）h vs.（78.8±12.3）h，t=-12.189，P=0.000]；首次流质饮食时间较短[（89.0±15.0）h vs.（113.7±10.1）h，t=-13.597，P=0.000]；术后住院时间较短[（8.5±1.7）d vs.（10.2±2.4）d，t=-4.150，P=0.000]；但机器人组住院总费用较多[（83 538.1±10 911.0）元 vs.（70 640.4±11 659.0）元，t=6.338，P=0.000]。机器人组和腹腔镜组手术时间[（202.9±14.7）min vs.（207.0±14.2）min，t=0.566，P=0.572]、引流管留置时间[（5.9±1.4）d vs.（6.0±1.4）d，t=-0.516，P=0.557]和引流量[（202.7±87.0）mL vs.（200.0±87.1）mL，t=0.335，P=0.738]的差异无统计学意义。2组淋巴结清扫结果、肿瘤学结果和术后总体并发症的差异均无统计学意义（P>0.05）；2组环周切缘均为阴性。2组患者围手术期均无死亡。随访情况方面，机器人组175例（失访16例）平均随访17.4个月，3例老年患者因其他基础疾病死亡；腹腔镜组190例（失访23例）平均随访16.9个月，6例老年患者因其他基础疾病死亡。2组患者随访过程中均无复发，无腹壁切口疝、造口旁疝、造口坏死等严重并发症。结论：相比于腹腔镜手术，机器人直肠癌TME手术出血量少且术后胃肠道功能恢复快，安全可行，值得在临床推广应用。

Abstract

Objective: To compare short-term outcomes between robotic-assisted and laparoscopic total mesorectal excision (TME) for rectal cancer. Methods: A total of 365 patients diagnosed with rectal cancer in Gansu Provincial Hospital from January 2017 to January 2020 were included in this study

among which 175 patients underwent robotic-assisted TME (R-TME group) and 190 patients underwent laparoscopic TME (L-TME group). The data of intra-operative

post-operative and clinical follow-up were compared between the two groups. Results: Compared to the L-TME group

the R-TME group had significantly less amount of bleeding [ (94.8±55.6) mL vs. (127.4±42.1) mL

t=-2.739

P=0.007]

shorter first aerofluxus time [ (60.3±11.9) h vs. (78.8±12.3) h

t=-12.189

P=0.000]

shorter first liquid diet time [ (89.0±15.0) h vs. (113.7±10.1) h

t=-13.597

P=0.000]

shorter postoperative hospital stay [ (8.5±1.7) d vs. (10.2±2.4) d

t=-4.150

P=0.000]

but more in-patient costs [ (83 538.1±10 911.0) vs. (70 640.4±11 659.0)

t=6.338

P=0.000]. There were no significant differences between the two groups in operation time [ (202.9±14.7) min vs. (207.0±14.2) min

t=0.566

P=0.572]

postoperative drainage time [ (5.9±1.4) d vs. (6.0±1.4) d

t=-0.516

P=0.557]

and the volume of drainage [ (202.7±87.0) mL vs. (200.0±87.1) mL

t=0.335

P=0.738]. There was no significant difference in lymph node dissection

oncological results and overall postoperative complications between the two groups (P>0.05). The circumferential resection margin was negative in both groups. There was no death during the perioperative period. In terms of follow-up

175 patients (16 lost) in the R-TME group were followed up for an average of 17.4 months

and 3 elderly patients t died of other basic diseases. In the L-TME group

190 patients (23 lost) were followed up for an average of 16.9 months

and 6 elderly patients died of other basic diseases. No serious complications such as recurrence

incisional abdominal wall hernias and ostomy-related diseases occurred during the follow-up of the two groups. Conclusion: Compared with laparoscopic surgery

R-TME for rectal cancer with less bleeding and faster recovery of gastrointestinal function post operation

is safe

effective and worthy of clinical application.

关键词

直肠癌全直肠系膜切除术达芬奇机器人手术系统腹腔镜手术近期疗效

Keywords

rectal cancertotal mesorectal excisionda Vinci surgical systemlaparoscopic surgeryshort-term outcome

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