Comment on "Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach: Results From a Large Retrospective Cohort".
Comment on "Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach: Results From a Large Retrospective Cohort".
复制标题
对“直肠癌机器人手术提供优于腹腔镜手术的有利结果：大型回顾性队列的结果”的评论。
DOI：
10.1097/sla.0000000000004169
复制
发表时间：
2020
影响因子：
9
通讯作者：
Z. Xue
中科院分区：
文献类型：
--
作者：
Qu;Bin;Z. Xue
致编辑：我们怀着极大的兴趣阅读了Crippa等人最近发表的研究，感谢作者为我们提供了直肠癌手术方法的新见解。我们知道，国际上最大的比较机器人辅助与传统腹腔镜治疗直肠癌效果的多中心RCT——ROLARR随机临床试验（RCT），并没有发现两组之间在转开腹手术风险和术后并发症方面存在显著差异。此外，来自中国的一项大型回顾性单中心比较研究也显示，机器人辅助手术组（n 1⁄4 556）和腹腔镜组（n 1⁄4 1029）的短期结果相似。相比之下，使用大样本量并包括连续的直肠癌患者，作者得出结论，与腹腔镜手术相比，机器人直肠癌手术改善了短期疗效。本研究的出现对外科医生进行直肠癌手术具有重要意义。然而，对于上述现象发生的原因，目前的研究似乎缺乏讨论。另外，我们有以下几点意见。首先，连续纳入所有直肠癌患者可在一定程度上减少选择偏倚。然而，作者似乎忽略了学习曲线对机器人手术的影响。基于单个外科医生进行的506例机器人直肠癌手术，Lee得出结论，第177例手术后手术效果有所改善。在目前的研究中，作者没有描述进行317例机器人手术的外科医生。此外，将患者分为不同的学习阶段可能会得到更多
To the Editor: We read with great interest the study recently published by Crippa et al, appreciating the authors for giving us a novel insight into the surgical approach to rectal cancer. As we know, the ROLARR randomized clinical trial (RCT), the biggest international multicenter RCT comparing the effect of robotic-assisted vs conventional laparoscopic for rectal cancer, did not find any significant differences in the risk of conversion to open laparotomy and postoperative complications between groups. In addition, a large retrospective single-center comparative study from China also showed similar short-term outcomes between roboticassisted surgery (n 1⁄4 556) and laparoscopic group (n 1⁄4 1029). On the contrast, using large sample size and including the consecutive rectal cancer patients, the authors concluded that robotic rectal cancer surgery improved the short-term outcomes when compared with laparoscopic surgery. The appearance of the present study is of great significance to surgeons performing rectal cancer surgery. However, the discussion on why the above phenomenon occurs in the present study seems to be lacking. In addition, we have the following comments. First, the consecutive inclusion of all rectal cancer patients may decrease the selection bias in a degree. However, the authors seem to miss the effect of the learning curve on robotic surgery. Based on 506 cases of robotic rectal cancer surgery performed by a single surgeon, Lee concluded that surgical outcomes improved after the 177th case. In the present study, the authors did not describe the surgeons who performed the 317 cases of robotic surgery. In addition, dividing patients into different learning phases may get more
影响因子：
9
作者：
Lee, Hyuk-Joon;Hyung, Woo Jin;Kim, Min-Chan
通讯作者：
Kim, Min-Chan