机器人与腹腔镜直肠癌全系膜切除术短期疗效对比分析
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摘要
目的对比机器人与腹腔镜直肠全系膜切除术的肿瘤根治效果和短期疗效。方法回顾性收集2015年7月至2017年10月期间于笔者所在医院肛肠科接受机器人直肠全系膜切除术患者80例,以及同期同一术者实施、病理分期相同的腹腔镜直肠全系膜切除术患者116例,采用队列研究方法分析两种手术方式的肿瘤根治效果及其短期疗效。结果机器人组术后住院时间[(11.20±5.80)d比(14.72±6.90) d,P=0.023],首次肛门排气时间[(3.28±1.64)d比(6.01±2.77)d,P<0.001]和首次进流质饮食时间[(4.46±1.62)d比(6.28±2.74) d,P<0.001]均比腹腔镜组缩短近3 d;术后尿潴留的发生率(2.50%比7.76%,P=0.016)机器人组明显低于腹腔镜组;但机器人组术中出血量较腹腔镜组多[(175.06±110.77) mL比(123.91±99.61)mL,P=0.031];2组的手术时间、淋巴结清扫数目、肿瘤下缘距下切缘距离和其他术后并发症发生率比较差异无统计学意义(P>0.05); 2组总费用的比较,机器人组总费用虽高于腹腔镜组,但差异无统计学意义[(85 623.91±13 310.50)元比(67 356.79±17 107.68)元,P=0.084]。结论机器人直肠全系膜切除术与腹腔镜手术相比,具有相同的肿瘤根治效果和较快的术后短期恢复。机器人直肠全系膜切除术的远期疗效有待进一步观察。
Objective To compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients' records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision(R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision(L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus [(3.28±1.64) d vs.(6.01±2.77) d, P<0.001],the time to the first postoperative oral fluid intake [(4.46±1.62) d vs.(6.28±2.74) d, P<0.001)and the length of hospital stay [(11.20±5.80)d vs.(14.72±6.90) d, P=0.023] of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention(2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group [(175.06±110.77) mL vs.(123.91±99.61) mL, P=0.031,). The operative time, number of lymph nodes harvested and distal margin were similar intergroup(P>0.05). The total cost was higher in the R-TME than in the L-TME group [(85 623.91±13 310.50) CNY vs.(67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. Conclusions Compared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.
Objective To compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients' records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision(R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision(L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus [(3.28±1.64) d vs.(6.01±2.77) d, P<0.001],the time to the first postoperative oral fluid intake [(4.46±1.62) d vs.(6.28±2.74) d, P<0.001)and the length of hospital stay [(11.20±5.80)d vs.(14.72±6.90) d, P=0.023] of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention(2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group [(175.06±110.77) mL vs.(123.91±99.61) mL, P=0.031,). The operative time, number of lymph nodes harvested and distal margin were similar intergroup(P>0.05). The total cost was higher in the R-TME than in the L-TME group [(85 623.91±13 310.50) CNY vs.(67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. Conclusions Compared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.
引文
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7Davies L, Gebski V, Hague W, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer:The ALaCaRT randomized clinical trial. JAMA, 2015,314(13):1356-1363.
8Jayne DG, Brown JM, Thorpe H, et al. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Bri J Surg, 2005, 92(9):1124-1132.
9Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc, 2006, 20(10):1521-1525.
10Kang J, Yoon KJ, Min BS, et al. The impact of robotic surgery for mid and low rectal cancer:a case-matched analysis of a 3-arm comparison-open, laparoscopic, and robotic surgery. Ann Surg,2013, 257(1):95-101.
11Hu L, Yao L, Li X, et al. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms:A metaanalysis of retrospective studies. Asian J Surg, 2018, 41(5):401-416.
12Hu LD, Li XF, Wang XY, et al. Robotic versus laparoscopic gastrectomy for gastric carcinoma:a meta-analysis of efficacy and safety. Asian Pac J Cancer Prev, 2016, 17(9):4327-4333.
13苟云久,马继龙,姚亮,等.达芬奇机器人和胸腔镜辅助胸外科手术治疗非小细胞肺癌有效性和安全性的Meta分析.中国循证医学杂志, 2017,(6):47-54.
14Baek JH, Mckenzie S, Garcia-Aguilar J, et al. Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg, 2010, 251(5):882-886.
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16Pigazzi A, Luca F, Patriti A, et al. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol, 2010, 17(6):1614-1620.
17Zimmern A, Prasad L, Desouza A, et al. Robotic colon and rectal surgery:a series of 131 cases. World J Surg, 2010, 34(8):1954-1958.
18Tang B, Zhang C, Li C, et al. Robotic total mesorectal excision for rectal cancer:a series of 392 cases and mid-term outcomes from a single center in china. J Gastrointest Surg, 2017, 21(3):569-576.
19Ortiz-Oshiro E, Sánchez-Egido I, Moreno-Sierra J, et al. Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery:systematic review and meta-analysis. Int J Med Robot, 2012, 8(3):360-370.
20Yang Y, Wang F, Zhang P, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer:a meta-analysis. Ann Surg Oncol, 2012, 19(12):3727-3736.
21Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid-and distal rectal cancer. Surg Endosc, 2016, 31(7):2798-2807.
22Zhou B. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population. Chin J Epidemiol, 2002, 23(1):5-10.
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25中华医学会外科学分会腹腔镜与内镜外科学组.腹腔镜结直肠癌根治手术操作指南(2008版).中华胃肠外科杂志, 2009, 12(3):310-312.
26Edge SB, Compton CC. The American Joint Committee on Cancer:the 7th edition of the AJCC cancer staging manualand the future of TNM. Ann Surg Oncol, 2010, 17(6):1471-1474.
27Petersson J, Koedam TW, Bonjer HJ, et al. Bowel obstruction and ventral hernia after laparoscopic versus open surgery for rectal cancer in a randomized trial(COLORⅡ). Ann Surg, 2019, 269(1):53-57.
28V?lkel V, Draeger T, Gerken M, et al. Long-term oncologic outcomes after laparoscopic vs. open colon cancer resection:a high-quality population-based analysis in a Southern German district. Surg Endosc, 2018, 32(10):4138-4147.
29陆淼炯,褚卫建.腹腔镜手术与传统开腹术治疗低位直肠癌的优势及疗效比较.浙江创伤外科, 2018, 23(3):484-485.
30Pinar I, Fransgaard T, Thygesen LC, et al. Long-term outcomes of robot-assisted surgery in patients with colorectal cancer. Ann Surg Oncol, 2018, 25(13):3906-3912.
31Yamaguchi T, Kinugasa Y, Shiomi A, et al. Short-and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer:results of a single high-volume center in Japan. Int J Colorectal Dis,2018, 33(12):1755-1762.
32Aselmann H, Kersebaum JN, Bernsmeier A, et al. Robotic-assisted total mesorectal excision(TME)for rectal cancer results in a significantly higher quality of TME specimen compared to the laparoscopic approach-report of a single-center experience. Int J Colorectal Dis, 2018, 33(11):1575-1581.
33Ohtani H, Maeda K, Nomura S, et al. Meta-analysis of robotassisted versus laparoscopic surgery for rectal cancer. In Vivo, 2018,32(3):611-623.
34Fransgaard T, Pinar I, Thygesen LC, et al. Association between robot-assisted surgery and resection quality in patients with colorectal cancer. Surg Oncol, 2018, 27(2):177-184.
35Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome. Colorectal Dis,2012, 14(4):e134-e156.
36王勉,李前进,郑建勇,等.达芬奇机器人与腹腔镜手术在直肠癌根治术中的病例对比研究.中华结直肠疾病电子杂志, 2015,4(1):40-44.
37Feroci F, Vannucchi A, Bianchi PP, et al. Total mesorectal excision for mid and low rectal cancer:Laparoscopic vs robotic surgery.World J Gastroenterol, 2016, 22(13):3602-3610.
38Yamaguchi T, Kinugasa Y, Shiomi A, et al. Robotic-assisted vs.conventional laparoscopic surgery for rectal cancer:short-term outcomes at a single center. Surg Today, 2016, 46(8):957-962.
39Baik SH, Ko YT, Kang CM, et al. Robotic tumor-specific mesorectal excison of rectal cancer:short-term outcome of a pilot randomized trial. Surg Endosc, 2008, 22(7):1601-1608.
40Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer(MRC CLASICC trial):multicentre, randomised controlled trial. Lancet, 2005, 365(9472):1718-1726.
41Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma:3-year results of the UK MRC CLASICC Trial Group. J Clinical Oncol,2007, 25(21):3061-3068.
42邹震,唐博,刘东宁,等.机器人与腹腔镜辅助中低位直肠癌根治术近期疗效比较的单中心随机对照研究.中国普通外科杂志,2018, 27(4):408-413.
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2Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection(laparoscopic colectomy). Surg Laparosc Endosc, 1991,1(3):144-150.
3Clinical Outcomes of Surgical Therapy Study Group, Nelson H,Sargent DJ, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med, 2004, 350(20):2050-2059.
4Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer:short-term outcomes of a randomised trial. Lancet Oncol, 2005, 6(7):477-484.
5Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopyassisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer:a randomised trial. Lancet, 2002,5359(9325):2224-2229.
6Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg, 2010,97(11):1638-1645.
7Davies L, Gebski V, Hague W, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer:The ALaCaRT randomized clinical trial. JAMA, 2015,314(13):1356-1363.
8Jayne DG, Brown JM, Thorpe H, et al. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Bri J Surg, 2005, 92(9):1124-1132.
9Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc, 2006, 20(10):1521-1525.
10Kang J, Yoon KJ, Min BS, et al. The impact of robotic surgery for mid and low rectal cancer:a case-matched analysis of a 3-arm comparison-open, laparoscopic, and robotic surgery. Ann Surg,2013, 257(1):95-101.
11Hu L, Yao L, Li X, et al. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms:A metaanalysis of retrospective studies. Asian J Surg, 2018, 41(5):401-416.
12Hu LD, Li XF, Wang XY, et al. Robotic versus laparoscopic gastrectomy for gastric carcinoma:a meta-analysis of efficacy and safety. Asian Pac J Cancer Prev, 2016, 17(9):4327-4333.
13苟云久,马继龙,姚亮,等.达芬奇机器人和胸腔镜辅助胸外科手术治疗非小细胞肺癌有效性和安全性的Meta分析.中国循证医学杂志, 2017,(6):47-54.
14Baek JH, Mckenzie S, Garcia-Aguilar J, et al. Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg, 2010, 251(5):882-886.
15Bianchi PP, Ceriani C, Locatelli A, et al. Robotic versus laparoscopic total mesorectal excision for rectal cancer:a comparative analysis of oncological safety and short-term outcomes. Surg Endosc, 2010, 24(11):2888-2894.
16Pigazzi A, Luca F, Patriti A, et al. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol, 2010, 17(6):1614-1620.
17Zimmern A, Prasad L, Desouza A, et al. Robotic colon and rectal surgery:a series of 131 cases. World J Surg, 2010, 34(8):1954-1958.
18Tang B, Zhang C, Li C, et al. Robotic total mesorectal excision for rectal cancer:a series of 392 cases and mid-term outcomes from a single center in china. J Gastrointest Surg, 2017, 21(3):569-576.
19Ortiz-Oshiro E, Sánchez-Egido I, Moreno-Sierra J, et al. Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery:systematic review and meta-analysis. Int J Med Robot, 2012, 8(3):360-370.
20Yang Y, Wang F, Zhang P, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer:a meta-analysis. Ann Surg Oncol, 2012, 19(12):3727-3736.
21Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid-and distal rectal cancer. Surg Endosc, 2016, 31(7):2798-2807.
22Zhou B. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population. Chin J Epidemiol, 2002, 23(1):5-10.
23中国抗癌协会大肠癌专业委员会腹腔镜外科学组,中华医学会外科分会腹腔镜与内镜外科学组.腹腔镜结肠直肠癌根治手术操作指南(2006版).外科理论与实践, 2006, 11(5):462-464.
24许剑民,秦新裕,余佩武.机器人结直肠癌手术专家共识(2015).中华结直肠疾病电子杂志, 2015, 14(6):1305-1310.
25中华医学会外科学分会腹腔镜与内镜外科学组.腹腔镜结直肠癌根治手术操作指南(2008版).中华胃肠外科杂志, 2009, 12(3):310-312.
26Edge SB, Compton CC. The American Joint Committee on Cancer:the 7th edition of the AJCC cancer staging manualand the future of TNM. Ann Surg Oncol, 2010, 17(6):1471-1474.
27Petersson J, Koedam TW, Bonjer HJ, et al. Bowel obstruction and ventral hernia after laparoscopic versus open surgery for rectal cancer in a randomized trial(COLORⅡ). Ann Surg, 2019, 269(1):53-57.
28V?lkel V, Draeger T, Gerken M, et al. Long-term oncologic outcomes after laparoscopic vs. open colon cancer resection:a high-quality population-based analysis in a Southern German district. Surg Endosc, 2018, 32(10):4138-4147.
29陆淼炯,褚卫建.腹腔镜手术与传统开腹术治疗低位直肠癌的优势及疗效比较.浙江创伤外科, 2018, 23(3):484-485.
30Pinar I, Fransgaard T, Thygesen LC, et al. Long-term outcomes of robot-assisted surgery in patients with colorectal cancer. Ann Surg Oncol, 2018, 25(13):3906-3912.
31Yamaguchi T, Kinugasa Y, Shiomi A, et al. Short-and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer:results of a single high-volume center in Japan. Int J Colorectal Dis,2018, 33(12):1755-1762.
32Aselmann H, Kersebaum JN, Bernsmeier A, et al. Robotic-assisted total mesorectal excision(TME)for rectal cancer results in a significantly higher quality of TME specimen compared to the laparoscopic approach-report of a single-center experience. Int J Colorectal Dis, 2018, 33(11):1575-1581.
33Ohtani H, Maeda K, Nomura S, et al. Meta-analysis of robotassisted versus laparoscopic surgery for rectal cancer. In Vivo, 2018,32(3):611-623.
34Fransgaard T, Pinar I, Thygesen LC, et al. Association between robot-assisted surgery and resection quality in patients with colorectal cancer. Surg Oncol, 2018, 27(2):177-184.
35Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome. Colorectal Dis,2012, 14(4):e134-e156.
36王勉,李前进,郑建勇,等.达芬奇机器人与腹腔镜手术在直肠癌根治术中的病例对比研究.中华结直肠疾病电子杂志, 2015,4(1):40-44.
37Feroci F, Vannucchi A, Bianchi PP, et al. Total mesorectal excision for mid and low rectal cancer:Laparoscopic vs robotic surgery.World J Gastroenterol, 2016, 22(13):3602-3610.
38Yamaguchi T, Kinugasa Y, Shiomi A, et al. Robotic-assisted vs.conventional laparoscopic surgery for rectal cancer:short-term outcomes at a single center. Surg Today, 2016, 46(8):957-962.
39Baik SH, Ko YT, Kang CM, et al. Robotic tumor-specific mesorectal excison of rectal cancer:short-term outcome of a pilot randomized trial. Surg Endosc, 2008, 22(7):1601-1608.
40Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer(MRC CLASICC trial):multicentre, randomised controlled trial. Lancet, 2005, 365(9472):1718-1726.
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