【评论】局部晚期直肠癌术前放化疗后机器人与腹腔镜腹会阴联合切除术的疗效比较

[Comment]Robotic versus laparoscopic abdominoperineal resection for locally advanced rectal cancer following preoperative chemoradiotherapy

目的机器人手术与腹腔镜手术在直肠癌治疗中的对比研究已被广泛报道,然而,关于机器人腹会阴联合切除术的报道仍较少。本研究的目的是比较机器人手术和腹腔镜手术在局部晚期直肠癌患者在术前放化疗后进行腹会阴联合切除术的效果,以确定该术式在局部晚期直肠癌患者治疗中的有效性。方法回顾性研究2012年12月至2022年9月在东京大学医院就诊的采用机器人或腹腔镜腹会阴联合切除术的43例术前接受术前放化疗的局部晚期直肠癌患者,根据手术方式的不同分为机器人组(n=22)和腹腔镜组(n=21),评估两组的临床病理因素、手术情况及短期和长期结局。结果机器人组和腹腔镜组中位随访时间分别为36个月和48个月,两组在手术时间、术中出血量、总体并发症发生率方面比较差异无统计学意义。腹腔镜组器官/腔隙手术部位感染发生率高于机器人组(38.1%vs.9.1%,P=0.034),机器人组3年总生存率高于腹腔镜组(95%vs.67%,P=0.029),但3年无复发生存率和3年局部复发率两组间比较差异无统计学意义。机器人组术后第4天引流量>500 mL的患者比例少于腹腔镜组(0%vs.20.0%,P=0.043),术后引流时间比较差异无统计学意义。结论机器人腹会阴联合切除术导致的器官/腔隙手术部位感染发生率较腹腔镜手术低,机器人手术可能是接受新辅助放化疗后局部晚期直肠癌患者进行腹会阴联合切除术的有效方法。

Background/aim The usefulness of robotic surgery compared to laparoscopic surgery for rectal cancer has been reported;however,few reports exist on robotic abdominoperineal resection(APR).The aim of this study was to compare the outcomes of robotic and laparoscopic surgery to determine their usefulness in patients with locally advanced rectal cancer who had undergone preoperative chemoradiotherapy(CRT).Patients and methods This retrospective study included 43 patients with locally advanced rectal cancer who underwent preoperative CRT and robotic(22 patients)or laparoscopic APR(21 patients)between December 2012 and September 2022.We examined the short-and long-term outcomes in the robotic and laparoscopic groups.Results The median follow-up durations were 36 and 48 months for the robotic and laparoscopic groups,respectively.No significant differences in operative time,intraoperative blood loss,or overall complication rates were observed.However,the incidence of organ/space surgical site infection(SSI)was significantly lower in the robotic surgery group than in the laparoscopic group(9.1%vs.38.1%,P=0.034)and the 3-year overall survival rate was significantly higher in the robotic surgery group than in the laparoscopic group(95%vs.67%,P=0.029).Conclusion Robotic APR was associated with a significantly lower rate of organ/space SSIs than the laparoscopic approach,indicating the usefulness of the robotic approach.