Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging
Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging
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DOI：
10.1016/j.ygyno.2012.02.023
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发表时间：
2012-06-01
影响因子：
4.7
通讯作者：
Fowler, Jeffrey M.
中科院分区：
文献类型：
--
作者：
Backes, Floor J.;Brudie, Lorna A.;Fowler, Jeffrey M.
客观的。尽管机器人手术的术中和术后即刻并发症相对较低，但对长期发病率知之甚少。我们着手评估子宫内膜癌分期机器人手术后的短期和长期发病率。方法。 2006 年至 2009 年间，来自两个机构的所有接受 EMCA 机器人分期的患者均已被识别。回顾性审查患者病历的手术并发症和术后发病率。结果。已确定 503 名患者。尽管BMI中位数从29.9（范围19-52）增加到32（范围17-70）（p=0.03），但2006-2007年和2008-2009年间并发症发生率没有差异。 6.4%的病例转为剖腹手术。中位停留时间为 1 天（范围 1-46）。未发生膀胱切开术、2 例肠切开术、1 例输尿管损伤和 5 例血管损伤（1.6% 术中并发症）。 38 名患者 (7.6%) 出现严重术后并发症，11 名患者 (2.2%) 出现伤口感染，15 名患者 (3%) 在 30 天的手术期间需要输血。机器人病例的总静脉血栓栓塞 (VIE) 率为 1.7%。 5 名 (1%) 患者出现袖带部分裂开，需要保守治疗；7 名 (1.4%) 患者出现完全裂开，需要缝合； 63 名（13.4%）接受机器人分期的患者出现淋巴水肿，其中 40 名（8%）需要物理治疗。结论。这项研究为接受机器人辅助子宫切除术和淋巴结切除术的最大患者群体之一（92.6%）提供了发病率评估。我们的数据表明，机器人手术分期可以安全地进行，短期并发症的风险较低，而淋巴水肿是最常见的长期发病率。 (C) 2012 Elsevier Inc. 保留所有权利。
Objective. Although intra-operative and immediate postoperative complications of robotic surgery are relatively low, little is known about long-term morbidity. We set out to assess both short- and long-term morbidities after robotic surgery for endometrial cancer staging.Methods. All patients who underwent robotic staging for EMCA between 2006 and 2009 from two institutions were identified. Patient charts were retrospectively reviewed for surgical complications and postoperative morbidities.Results. Five hundred three patients were identified. No differences in complication rates were found between 2006-2007 and 2008-2009, even though the median BMI increased from 29.9 (range 19-52) to 32 (range 17-70) (p=0.03). 6.4% of cases were converted to laparotomy. Median length of stay was one day (range 1-46). No cystotomies, two enterotomies, one ureteric injury, and five vessel injuries occurred (1.6% intra-operative complications). Thirty-eight (7.6%) patients developed major postoperative complications, 11(2.2%) had wound infections, and 15 (3%) required a transfusion in the 30-day pen-operative period. The total venous thromboembolism (VIE) rate for robotic cases was 1.7%. Partial cuff dehiscence managed conservatively occurred in 5 (1%) and complete dehiscence requiring closure in 7 (1.4%) patients; Sixty-three (13.4%) patients who had robotic staging developed lymphedema, with 40 (8%) requiring physical therapy.Conclusions. This study provides one of the largest cohorts of patients with robotic-assisted hysterectomy and lymphadenectomy (in 92.6%) with an assessment of morbidity. Our data demonstrates that robotic surgical staging can be safely performed with a low risk of short-term complications and lymphedema is the most frequent long-term morbidity. (C) 2012 Elsevier Inc. All rights reserved.