达芬奇机器人与腹腔镜直肠癌全系膜切除术短期和中期疗效的比较

Robotic versus laparoscopic total mesorectal excision surgery in rectal cancer:short-mid term oncological outcomes

目的探讨机器人与腹腔镜全直肠系膜切除术在直肠癌治疗中的安全性及远期疗效。方法回顾性分析2015年8月至2021年3月甘肃省人民医院肛肠科行直肠癌全系膜切除术240例患者的临床病理资料,其中112例行腹腔镜全直肠系膜切除术(L-TME组),128例行机器人全直肠系膜切除术(R-TME组),比较两组患者的术中、术后及随访情况。结果L-TME组中转开腹率高于R-TME组(5.4%比0.8%,χ^(2)=4.417,P=0.036);L-TME组并发症的发生率高于R-TME组(32.1%比17.2%,χ^(2)=7.290,P=0.007);L-TME组环切缘阳性率高于R-TME组(7.1%比1.6%,χ^(2)=4.658,P=0.031);L-TME组3年无病生存率和总生存率低于R-TME组(74.1%比85.2%,χ^(2)=4.962,P=0.026;81.3%比91.4%,χ^(2)=5.494,P=0.019);在AJCC分期Ⅲ期患者中,L-TME组3年无病生存率和总生存率低于R-TME组(52.5%比76.1%,χ^(2)=5.799,P=0.016;65.0%比84.8%,χ^(2)=4.787,P=0.029),差异均有统计学意义。结论与L-TME组相比,R-TME组可以获得更好的肿瘤预后,对直肠癌患者更有利,特别是对Ⅲ期直肠癌患者。

Objective To investigate the safety and mid-term efficacy of robotic versus laparoscopic total mesorectal excision surgery in rectal cancer.Methods A total of 240 patients were diagnosed with rectal cancer at the Anorectal Department of Gansu Provincial Hospital from Aug 2015 to Mar 2021,112 patients underwent laparoscopic total mesorectal excision(L-TME group)and 128 patients did robotic-assisted total mesorectal excision(R-TME group).Results Compared to the R-TME group,the L-TME group had higher conversion rate(5.4%vs.0.8%,χ^(2)=4.417,P=0.036),higher incidence of complications(32.1%vs.17.2%,χ^(2)=7.290,P=0.007),higher circumferential resection margin involvement(7.1%vs.1.6%,χ^(2)=4.658,P=0.031),lower 3-year DFS and OS(74.1%vs.85.2%,χ^(2)=4.962,P=0.026)and(81.3%vs.91.4%,χ^(2)=5.494,P=0.019),lower 3-year DFS and OS in AJCC stageⅢ(52.5%vs.76.1%,χ^(2)=5.799,P=0.016)and(65.0%vs.84.8%,χ^(2)=4.787,P=0.029).Conclusion R-TME can achieve better oncological outcomes and is more beneficial for RC patients compared with L-TME,especially for those with stageⅢrectal cancers.