Robotic-assisted Colorectal Surgery in the United States: A Nationwide Analysis of Trends and Outcomes
Robotic-assisted Colorectal Surgery in the United States: A Nationwide Analysis of Trends and Outcomes
复制标题
DOI：
10.1007/s00268-013-2024-7
复制
发表时间：
2013-12-01
影响因子：
2.6
通讯作者：
Pigazzi, Alessio
中科院分区：
文献类型：
--
作者：
Halabi, Wissam J.;Kang, Celeste Y.;Pigazzi, Alessio
虽然机器人辅助结直肠手术(RACS)正变得越来越受欢迎，但将其结果与其他已有技术进行比较的数据仍然局限于小病例系列。此外，在国家层面上还没有大型研究来评估RACS的趋势。我们回顾了2009-2010年间全国住院患者的机器人辅助和腹腔镜结直肠手术治疗癌症、良性息肉和憩室病的情况。分析了不同环境、适应症和人口统计学中的趋势。多因素回归分析比较了RACS和传统腹腔镜手术(CLS)的结果。在研究期间，估计有128,288例结直肠手术是通过微创技术进行的，其中2.78%的病例使用了RACS。从2009年到2010年，机器人在所有医院的使用都有所增加，但在大型、城市和教学医院中仍然更为普遍。直肠癌是RACS最常见的适应症，在男性患者中有选择性使用的倾向。多因素分析显示，结肠(11,601.39美元；95%CI 6,921.82~16,280.97)和直肠(12,964.90美元；95%CI 6,534.79~19,395.01)患者的住院费用较高，结肠癌患者术后出血率较高(OR=2.15；95%CI 1.27~3.65)。在住院时间、发病率、吻合口漏和肠梗阻方面，RACS与CLS相似。在机器人结肠和直肠手术中，中转开腹手术的比例显著降低(0.41；95%可信区间0.25-0.67)和(0.10；95%可信区间0.06-0.16)。RACS在美国的应用仍然有限。然而，在研究期间，尽管相关费用较高，而且在结果方面没有真正优于腹腔镜术，但它的使用量仍在增加。唯一的优势是转换率较低。
While robotic-assisted colorectal surgery (RACS) is becoming increasingly popular, data comparing its outcomes to other established techniques remain limited to small case series. Moreover, there are no large studies evaluating the trends of RACS at the national level.The Nationwide Inpatient Sample 2009-2010 was retrospectively reviewed for robotic-assisted and laparoscopic colorectal procedures performed for cancer, benign polyps, and diverticular disease. Trends in different settings, indications, and demographics were analyzed. Multivariate regression analysis was used to compare selected outcomes between RACS and conventional laparoscopic surgery (CLS).An estimated 128,288 colorectal procedures were performed through minimally invasive techniques over the study period, and RACS was used in 2.78 % of cases. From 2009 to 2010, the use of robotics increased in all hospital settings but was still more common in large, urban, and teaching hospitals. Rectal cancer was the most common indication for RACS, with a tendency toward its selective use in male patients. On multivariate analysis, robotic surgery was associated with higher hospital charges in colonic ($11,601.39; 95 % CI 6,921.82-16,280.97) and rectal cases ($12,964.90; 95 % CI 6,534.79-19,395.01), and higher rates of postoperative bleeding in colonic cases (OR = 2.15; 95 % CI 1.27- 3.65). RACS was similar to CLS with respect to length of hospital stay, morbidity, anastomotic leak, and ileus. Conversion to open surgery was significantly lower in robotic colonic and rectal procedures (0.41; 95 % CI 0.25-0.67) and (0.10; 95 % CI 0.06-0.16), respectively.The use of RACS is still limited in the United States. However, its use increased over the study period despite higher associated charges and no real advantages over laparoscopy in terms of outcome. The one advantage is lower conversion rates.