The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer
The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer
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DOI：
10.1016/j.ejso.2016.03.002
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发表时间：
2016-06-01
期刊：
影响因子：
3.8
通讯作者：
Iglesias, A. C.
中科院分区：
文献类型：
--
作者：
de Jesus, J. P.;Valadao, M.;Iglesias, A. C.
简介：直肠癌（RC）的微创手术现在广泛通过腹腔镜方法进行，但机器人辅助手术可以克服腹腔镜在RC治疗中的一些局限性。我们比较了机器人，腹腔镜和开放式全直肠系膜切除术（TME）RC在我们的institution.Methods：连续提交机器人手术的中，低直肠腺癌患者的阳性圆周边缘率进行了比较腹腔镜和开放的方法。从我们的前瞻性数据库中，将2012年至2015年接受机器人辅助直肠手术的59例患者（RTME组）与我们的历史对照组进行了比较，历史对照组包括2008年7月至2012年2月的200例开放性TME（OTME组）和41例腹腔镜TME（LTME组）。主要终点是比较三组之间的累及环周切除边缘（CRM）的比率和平均CRM。次要终点是比较三组之间切除淋巴结的平均数量。结果：20例患者（15.5%）在OTME，4例（16%）在LTME和9例（16.4%）在RTME（p = 0.988）中显示CRM参与。OTME、LTME和RTME的平均CRM分别为0.6 cm（0-2.7）、0.7 cm（0-2.0）和0.6 cm（0-2.0）（p = 0.960）。总体平均LN收获量为14（0-56）; OTME为16（0-52），LTME为13（1-56），RTME为10（0-45）（p = 0.156）。结论：我们的研究结果表明，机器人TME与开放和腹腔镜技术相比具有相同的肿瘤学短期结果，可以安全地用于治疗中低位直肠癌。(C)2016爱思唯尔有限公司版权所有
Introduction: Minimally invasive surgery for rectal cancer (RC) is now widely performed via the laparoscopic approach, but robotic-assisted surgery may overcome some limitations of laparoscopy in RC treatment. We compared the rate of positive circumferential margins between robotic, laparoscopic and open total mesorectal excision (TME) for RC in our institution.Methods: Mid and low rectal adenocarcinoma patients consecutively submitted to robotic surgery were compared to laparoscopic and open approach. From our prospective database, 59 patients underwent robotic-assisted rectal surgery from 2012 to 2015 (RTME group) were compared to our historical control group comprising 200 open TME (OTME group) and 41 laparoscopic TME (LTME group) approaches from July 2008 to February 2012. Primary endpoint was to compare the rate of involved circumferential resection margins (CRM) and the mean CRM between the three groups. Secondary endpoint was to compare the mean number of resected lymph nodes between the three groups.Results: CRM involvement was demonstrated in 20 patients (15.5%) in OTME, 4 (16%) in LTME and 9 (16.4%) in the RTME (p = 0.988). The mean CRM in OTME, LTME and RTME were respectively 0.6 cm (0-2.7), 0.7 cm (0-2.0) and 0.6 cm (0-2.0) (p = 0.960). Overall mean LN harvest was 14 (0-56); 16 (0-52) in OTME, 13 (1-56) in LTME and 10 (0-45) in RTME (p = 0.156).Conclusion: Our results suggest that robotic TME has the same oncological short-term results when compared to the open and laparoscopic technique, and it could be safely offered for the treatment of mid and low rectal cancer. (C) 2016 Elsevier Ltd. All rights reserved.