Oncologic and Clinicopathologic Outcomes of Robot-Assisted Total Mesorectal Excision for Rectal Cancer
Oncologic and Clinicopathologic Outcomes of Robot-Assisted Total Mesorectal Excision for Rectal Cancer
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DOI：
10.1097/dcr.0000000000000385
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发表时间：
2015-07-01
影响因子：
3.9
通讯作者：
Prasad, Leela M.
中科院分区：
文献类型：
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作者：
Pai, Ajit;Marecik, Slawomir J.;Prasad, Leela M.
背景：微创直肠癌手术具有挑战性和技术难度。机器人技术提供了一个稳定的手术平台，具有放大的三维视觉和配备的仪器，可以促进微创手术。短期和长期结果的数据表明，其结果与腹腔镜和开放手术相当。目的：我们评估直肠癌机器人手术的围手术期、临床病理和肿瘤学结果。设计：本研究对前瞻性患者数据库进行了7年的回顾。背景：手术在一家三级医院的结直肠科进行。患者：自2005年8月至2012年10月，101例直肠癌患者采用机器人入路进行手术。直肠癌定义为离肛门边缘15cm以内的肿瘤。干预措施：患者接受完全机器人或混合腹腔镜-机器人手术，并由机器人进行直肠解剖。主要观察指标：检查手术和围手术期数据、病理结果、无病生存期和总生存期。结果：男性63例（62.4%），女性38例（37.6%）；平均年龄61.5岁。中直肠和低位直肠癌占74.2%。74.3%的患者术前给予放化疗。4例转为开腹手术。周缘阳性为5%，中位淋巴结率为15%。平均随访34.9个月，无病生存率为79.2%，总生存率为90.1%。机器人手术的平均费用为22,640美元，而手辅助腹腔镜手术的平均费用为18,330美元（p = 0.005）。局限性：这是一项单机构研究，没有直接比较组。结论：机器人手术用于直肠癌切除是安全可行的。它具有较低的转换率，满足病理充分性的所有措施，并提供可接受的肿瘤结果。机器人手术比人工辅助的腹腔镜手术要昂贵得多。缺乏随机数据限制了目前推荐它作为护理标准。
BACKGROUND: Minimally invasive rectal cancer surgery is challenging and technically difficult. Robotic technology offers a stable surgical platform with magnified 3-dimensional vision and endowristed instruments, which may facilitate the minimally invasive procedure. Data on short-term and long-term outcomes indicate results comparable to laparoscopic and open surgery.OBJECTIVE: We assessed the perioperative, clinicopathologic, and oncologic outcomes of robotic surgery for rectal cancer.DESIGN: This study was a review of a prospective database of patients over a 7-year period.SETTINGS: Procedures took place in the colorectal division at a tertiary hospital.PATIENTS: From August 2005 to October 2012, 101 patients with rectal cancer were operated on using the robotic approach. Rectal cancers were defined as tumors within 15cm from the anal verge.INTERVENTIONS: Patients received either a totally robotic or a hybrid laparoscopic-robotic operation with rectal dissection performed robotically.MAIN OUTCOME MEASURES: Operative and perioperative data, pathologic outcomes, and disease-free and overall survival were examined.RESULTS: There were 63 men (62.4%) and 38 women (37.6%) in the study; the mean age was 61.5 years. Mid rectal and low rectal cancers composed 74.2% of cases. Preoperative chemoradiation was given to 74.3% of patients. Four conversions to open surgery occurred. Circumferential margin positivity was 5%, and median lymph node yield was 15. At a mean follow-up of 34.9 months, the disease-free survival was 79.2% and overall survival 90.1%. The mean cost of robotic surgery was $22,640 versus $18,330 for the hand-assisted laparoscopic approach (p = 0.005).LIMITATIONS: This was a single-institution study with no head-to-head comparative group.CONCLUSIONS: Robotic surgery for rectal cancer extirpation is safe and feasible. It has a low conversion rate, satisfies all measures of pathologic adequacy, and offers acceptable oncologic outcomes. Robotic surgery is significantly more expensive than hand-assisted laparoscopic surgery. The absence of randomized data limits recommending it as the standard of care at present.