机器人与腹腔镜直肠癌根治术疗效对比分析:一项倾向性评分匹配队列研究

Comparative analysis on clinical effects of robotic and laparoscopic radical resection for rectal cancer : A propensity score matched cohort study

目的 比较分析机器人与腹腔镜直肠癌根治术的临床疗效。方法 回顾性分析2016-07-01—2021-03-31在陆军军医大学大坪医院普通外科接受机器人(151例)及腹腔镜(1021例)直肠癌根治术病人的临床资料。通过倾向性评分后进行1∶1匹配,将病人分为机器人组和腹腔镜组(两组各150例),比较二组病人术后30 d短期结局及术后3年生存结局。结果 两组术后30 d Clvien-Dindo分级(CDC)、总并发症发生率、严重并发症发生率差异均无统计学意义。机器人组吻合口瘘发生率低于腹腔镜组(6.6%vs. 14.6%,χ^(2)=4.212,P=0.040),其余各种并发症两组间差异均无统计学意义。与腹腔镜组相比,机器人组中转开放手术率(2.0%vs. 6.7%,χ^(2)=3.940,P=0.047)和30 d再手术率(2.7%vs. 9.3%,χ^(2)=5.910,P=0.015)更低,且淋巴结检出数目更多[13(10~16)枚vs. 11(8~14)枚,Z=-3.662,P=0.000]、术后住院时间更短[7(6~9)d vs. 8(7~11)d,Z=-4.601,P=0.000]、手术时间更长[(197.0±54.6)vs.(151.3±51.8)min,t=7.386,P=0.000]、住院总费用更高[(94518.3±15670.7)vs.(81358.4±20228.5)元,t=6.229,P=0.000]。两组保肛率等其余短期结局差异无统计学意义。两组术后3年总生存率及无病生存率差异无统计学意义,但在分层分析中,Ⅲ期病人中机器人组3年总生存率更高(91.3%vs. 67.9%,χ^(2)=3.988,P=0.046)。结论 与腹腔镜直肠癌根治术相比,机器人手术同样安全、有效,而且在改善吻合口瘘发生率等短期结局与提高部分病人的生存率方面有潜在优势。

ObjectiveTo investigate the therapeutic effects of robotic and laparoscopic radical resection for rectal can-cer.MethodsThe clinical data of patients who underwent robotic(151 cases) or laparoscopic radical resection(1021 cases) surgery for rectal cancer in Department of General Surgery, Daping Hospital, Army Medical University from July1, 2016 to March 31, 2021 were analyzed retrospectively. Patients in robotic and laparoscopic group were matched 1∶1 by propensity score,150 cases were included in each group,30-day short-term outcomes and 3-year survival outcomeswere compared between the two groups.RusultsThere were no significant differences between two groups in 30-dayClavien-Dindo classification(CDC), total complication rate, and severe complication rate. Anastomotic leakage rate islower in robotic group than laparoscopic group(6.6% vs. 14.6%, χ^(2)=4.212, P=0.040). Other various complications were al-most similar in two groups. Compared to laparoscopic surgery, robotic surgery was associated with lower conversion rate(2.0% vs. 6.7%, χ^(2)=3.940, P=0.047) and 30-day reoperation rate(2.7% vs. 9.3%, χ^(2)=5.910, P=0.015), more number ofretrieved lymph nodes[13(10~16) vs. 11(8~14), Z=-3.662, P=0.000], shorter postoperative length of stay[7(6~9)vs. 8(7~11), Z=-4.601, P=0.000], longer operative time[(197.0±54.6) vs.(151.3±51.8)min, t=7.386, P=0.000]andhigher in-patient cost[￥(94518.3±15670.7) vs. ￥(81358.4±20228.5), t=6.229, P=0.000]. Other short-term outcomessuch as sphincter-preserving rate revealed no signifi-cant differences in two groups. There were no differ-ences in 3-year overall survival and disease free sur-vival between two groups. However, in subgroups strat-ified by TNM staging, robotic group was associatedwith higher 3-year overall survival(91.3% vs. 67.9%, χ^(2)=3.988, P=0.046)in stage Ⅲ.ConclusionCompared with lapa-roscopic surgery, robotic surgical system for rectal cancer is also safe and effective, and has potential advantages in im-proving short-term outcomes such as the incidence of anastomotic leakage and improving the survival rate of some pa-tients.