Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer
Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer
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DOI：
10.1007/s00464-015-4266-y
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发表时间：
2016-02-01
影响因子：
3.1
通讯作者：
Kagawa, Hiroyasu
中科院分区：
文献类型：
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作者：
Yamaguchi, Tomohiro;Kinugasa, Yusuke;Kagawa, Hiroyasu
本研究的目的是通过比较机器人辅助腹腔镜侧方淋巴结清扫术（RALLD）与开放侧方淋巴结清扫术（OLLD）的短期结局，阐明机器人辅助腹腔镜侧方淋巴结清扫术（RALLD）治疗直肠癌的优势。关于进展期低位直肠癌的RALLD，回顾性、非对照性研究中仅有少数报道，病例数较少，2010年4月至2014年7月，共177例患者行直肠癌手术伴侧方淋巴结清扫。排除了4例接受传统腹腔镜外侧淋巴结清扫术的患者。因此，入组了173例患者，其中85例为RALLD，88例为OLLD。比较两组的围手术期结局、术后并发症及病理结果，RALLD组无需中转开放手术。RALLD组的保肛手术率显著高于OLLD组（p = 0.007）。RALLD组的手术时间显著长于OLLD组（p = 0.007）。RALLD组的失血量明显少于OLLD组（p < 0.001）。RALLD组的伤口感染、小肠梗阻、吻合口瘘和尿潴留的发生率显著低于OLLD组。RALLD的淋巴结清扫数和切缘阳性率无显著性差异，RALLD治疗晚期低位直肠癌的近期疗效上级OLLD。
The aim of the present study was to clarify the advantages of robotic-assisted laparoscopic lateral lymph node dissection (RALLD) for rectal cancer by comparing its short-term outcomes with those of open lateral lymph node dissection (OLLD) in a large series from a single center. In terms of RALLD for advanced lower rectal cancer, there are only a few reports with a small number of cases in retrospective, non-comparative studies.From April 2010 to July 2014, a total of 177 patients underwent rectal cancer surgery with lateral lymph node dissection. Four patients who underwent conventional laparoscopic lateral lymph node dissection were excluded. Thus, 173 patients were enrolled, with 85 RALLD and 88 OLLD cases. Perioperative outcomes, postoperative complications, and pathological results were compared between the groups.No conversion to open surgery was necessary in the RALLD group. The rate of sphincter-preserving procedure was significantly higher in the RALLD group than in the OLLD group (p = 0.007). Operative time was significantly longer in the RALLD group than in the OLLD group (p = 0.007). Blood loss was significantly less in the RALLD group than in the OLLD group (p < 0.001). The rates of wound infection, small bowel obstruction, anastomotic leakage, and urinary retention were significantly lower in the RALLD group than in the OLLD group. Numbers of harvested lymph nodes and positive resection margin rates showed no significant differences.The short-term outcomes of RALLD may be superior to those of OLLD for advanced lower rectal cancer.