Total Mesorectal Excision for Rectal Cancer: The Potential Advantage of Robotic Assistance
Total Mesorectal Excision for Rectal Cancer: The Potential Advantage of Robotic Assistance
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DOI：
10.1007/dcr.0b013e3181f22f1f
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发表时间：
2010-12-01
影响因子：
3.9
通讯作者：
Abcarian, Herand
中科院分区：
文献类型：
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作者：
deSouza, Ashwin L.;Prasad, Leela M.;Abcarian, Herand
目得：本研究的目的是分析da芬奇S HD机器人系统在直肠腺癌直肠系膜切除术中的安全性、可行性和有效性，旨在确定机器人在该手术中的潜在优势。方法：本研究是对前瞻性维护的44例机器人连续病例数据库的回顾性审查，在2005年8月至2010年2月期间进行的直肠腺癌辅助直肠系膜切除术。患者的人口统计学资料，围手术期的结果，并发症进行了评价，并与类似的已发表的报告和相关literature.RESULTS：有28（63.6%）男性和16（36.4%）女性，平均年龄为63岁。大多数患者超重或肥胖，88.7%的病变位于中低位直肠。我们进行了36例低位前切除术（6例括约肌间切除术）和8例腹会阴切除术，中位失血量为150 mL（范围，50-1000），中位手术时间为347分钟（范围，155-510），中位住院时间为5天（范围，3-36）。所有患者的中位淋巴结转移率为14（范围，5-45），环周切除边缘均为阴性。我们有1例远端切缘阳性（2.7%）、2例吻合口漏（5.6%）、1例死亡（2.7%）和2例转为开放入路（4.5%）。没有机器人相关的发病率发生在这series.CONCLUSIONS：这一系列的机器人辅助直肠癌全直肠系膜切除术的安全性和可行性方面与类似的已发表的报告相媲美。与腹腔镜相比，机器人直肠切除术的转换率较低，需要在大型随机试验中进行验证。
PURPOSE: The purpose of this study was to analyze the safety, feasibility, and efficacy of the da Vinci S HD robotic system in mesorectal excision for rectal adenocarcinoma, with the aim to identify areas of potential advantage for the robot in this procedure.METHODS: This study was conducted as a retrospective review of a prospectively maintained database of 44 consecutive cases of robot-assisted mesorectal excision for rectal adenocarcinoma performed between August 2005 and February 2010. Patient demographics, perioperative outcomes, and complications were evaluated and compared with similar published reports and relevant literature.RESULTS: There were 28 (63.6%) men and 16 (36.4%) women, with a mean age of 63 years. The majority of patients were either overweight or obese and 88.7% of lesions were in the mid or low rectum. We performed 36 low anterior resections (6 intersphincteric) and 8 abdominoperineal resections with a median blood loss of 150 mL (range, 50-1000), a median operative time of 347 minutes (range, 155-510), and a median length of stay of 5 days (range, 3-36). The median lymph node yield was 14 (range, 5-45) and the circumferential resection margin was negative in all patients. We had 1 distal margin positivity (2.7%), 2 anastomotic leaks (5.6%), 1 death (2.7%), and 2 conversions (4.5%) to the open approach. No robot-associated morbidity occurred in this series.CONCLUSIONS: This series compares favorably with similar published reports with regard to the safety and feasibility of robotic assistance in total mesorectal excision for rectal cancer. The lower conversion rates reported for robotic rectal resection compared with laparoscopy require validation in large randomized trials.