Hybrid abdominal robotic approach with conventional transanal total mesorectal excision (TaTME) for rectal cancer: feasibility and outcomes from a single institution
Hybrid abdominal robotic approach with conventional transanal total mesorectal excision (TaTME) for rectal cancer: feasibility and outcomes from a single institution
复制标题
DOI：
10.1007/s11701-019-01032-y
复制
发表时间：
2019-10-17
影响因子：
2.3
通讯作者：
Warrier, Satish
中科院分区：
文献类型：
--
作者：
Nikolic, Amanda;Waters, Peadar S.;Warrier, Satish
全直肠系膜切除术（TME）是目前公认的标准治疗直肠癌患者。已知完全TME与较低的复发率相关。据报道，机器人和内镜TaTME入路可在TME平面内提供出色的近端和远端直肠剥离，然而，在混合手术中结合两种入路可能会优化剥离平面的可视化，并提高周向和远端切缘率。本研究的目的是分析混合机器人腹部方法与传统的TaTME直肠癌的可行性。此外，还评估了病理学和患者结局。对前瞻性维护的数据库进行了审查，以评估2016年8月至2017年10月期间接受机器人TME手术治疗直肠肿瘤的所有患者。患者的人口统计资料，肿瘤的特点和结果进行了整理，从病人的图表和医院的数据库。所有患者均在多学科小组讨论后接受改良塞西尔入路。8名患者（7名男性，1名女性）接受了联合混合方法，中位年龄为60岁（范围47-73），BMI为29.5（范围20-39.1）kg/m2。距肛门直肠交界处（ARJ）的中位距离为7.5（范围4-13）cm。6例患者接受了新辅助放化疗治疗。患者的中位住院时间（LOS）为9天（范围4-33天）。没有遇到术中并发症，没有患者需要转为开放手术。并发症包括1例吻合口瘘和1例骶前积液。所有患者均进行了完整的TME和RO切除术，收获的淋巴结中位数为22（范围6-37）个淋巴结。这种混合技术是一种可行的，实用的和操作有利的方法，直肠癌手术的初步病理结果和并发症的轮廓等同于其他方法。
Total mesorectal excision (TME) is currently recognised as the standard of care for patients with rectal cancer. Complete TME is known to be associated with lower rates of recurrence. Robotic and endoscopic TaTME approaches are reported to offer excellent proximal and distal rectal dissection into the TME plane, however, combining both approaches in a hybrid procedure could potentially optimise visualisation of the dissection plane and confer improved circumferential and distal margin rates. The aim of this study was to analyse the feasibility of a hybrid robotic abdominal approach with conventional TaTME for rectal cancer. Furthermore, pathological and patient outcomes were assessed. A review of prospectively maintained databases was undertaken to assess all patients undergoing robotic TME surgery for rectal tumours from August 2016 to October 2017. Patient demographics, tumour characteristics and outcomes were collated from patient charts and hospital databases. All patients underwent a modified Cecil approach after multidisciplinary team discussion. Eight patients (7 male, 1 female) underwent a combined hybrid approach with a median age of 60 years (range 47-73) and BMI of 29.5 (range 20-39.1) kg/m(2). Median distance from the anorectal junction (ARJ) was 7.5 (range 4-13) cm. Six patients underwent neoadjuvant treatment with chemoradiotherapy. Patients had a median length of stay (LOS) of 9 (range 4-33) days. There were no intra-operative complications encountered and no patients required a conversion to an open procedure. Complications included one anastomotic leak and one presacral collection. All patients had a complete TME with RO resection with a median number of lymph nodes harvested was 22 (range 6-37) lymph nodes. This hybrid technique is a feasible, practical and operatively favourable approach to rectal cancer surgery with initial pathological outcomes and complication profile equivalent to other approaches.