Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on th...Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE) using the key words "rectum", "rectal", "cancer", "laparoscopy", "robot". After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection(1450 patients, 48.1%), followed by anterior resections(997 patients, 33%), ultra-low anterior resections(393 patients, 13%) and abdominoperineal resections(173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.展开更多
目的:探讨术后使用肠功能恢复汤(intestine function recovery decoction,IFRD)对前列腺癌术后早期肠道功能恢复的影响。方法:回顾性分析西安交通大学第一附属医院泌尿外科2012年10月至2017年6月完成前列腺癌手术患者的临床病理资料,共...目的:探讨术后使用肠功能恢复汤(intestine function recovery decoction,IFRD)对前列腺癌术后早期肠道功能恢复的影响。方法:回顾性分析西安交通大学第一附属医院泌尿外科2012年10月至2017年6月完成前列腺癌手术患者的临床病理资料,共计144例,根据术后是否进行了灌肠治疗及灌肠使用的方法分为未灌肠组、肥皂水组和IFRD组,对比研究三组患者术后恢复情况及差异。多因素Logistic(逐步法)回归进一步研究影响前列腺癌术后胃肠道功能恢复的危险因素。结果:一般基线资料比较显示三组患者之间无显著差异(P>0.05);Logistic多因素回归分析显示,手术方式、术前新辅助治疗、年龄大于65岁、术后合并症是影响术后胃肠道功能恢复的危险因素(P<0.05);术后情况比较显示,术后腹腔引流量、留置引流管时间以及术后住院时间IFRD组均显著优于其他两组(P<0.05);术后首次排便时间及饮水时间IFRD组均明显优于其他两组(P<0.05);与传统的灌肠剂肥皂水比较,IFRD组术后首次排便时间、引流量及引流时间分别为(3.24±1.51)d、(15.10±3.36)ml、(3.86±1.16)d,均明显低于肥皂水组(4.44±1.78)d、(23.38±17.20)ml、(4.51±2.11)d(P<0.05)。结论:根治性前列腺癌术后给予IFRD灌肠可显著减少腹腔引流量及引流管留置时间;可促进患者胃肠道功能的恢复以及缩短术后住院时间,有助于促进患者术后排气排便,降低术后近期并发症。展开更多
文摘Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE) using the key words "rectum", "rectal", "cancer", "laparoscopy", "robot". After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection(1450 patients, 48.1%), followed by anterior resections(997 patients, 33%), ultra-low anterior resections(393 patients, 13%) and abdominoperineal resections(173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.
文摘目的:探讨术后使用肠功能恢复汤(intestine function recovery decoction,IFRD)对前列腺癌术后早期肠道功能恢复的影响。方法:回顾性分析西安交通大学第一附属医院泌尿外科2012年10月至2017年6月完成前列腺癌手术患者的临床病理资料,共计144例,根据术后是否进行了灌肠治疗及灌肠使用的方法分为未灌肠组、肥皂水组和IFRD组,对比研究三组患者术后恢复情况及差异。多因素Logistic(逐步法)回归进一步研究影响前列腺癌术后胃肠道功能恢复的危险因素。结果:一般基线资料比较显示三组患者之间无显著差异(P>0.05);Logistic多因素回归分析显示,手术方式、术前新辅助治疗、年龄大于65岁、术后合并症是影响术后胃肠道功能恢复的危险因素(P<0.05);术后情况比较显示,术后腹腔引流量、留置引流管时间以及术后住院时间IFRD组均显著优于其他两组(P<0.05);术后首次排便时间及饮水时间IFRD组均明显优于其他两组(P<0.05);与传统的灌肠剂肥皂水比较,IFRD组术后首次排便时间、引流量及引流时间分别为(3.24±1.51)d、(15.10±3.36)ml、(3.86±1.16)d,均明显低于肥皂水组(4.44±1.78)d、(23.38±17.20)ml、(4.51±2.11)d(P<0.05)。结论:根治性前列腺癌术后给予IFRD灌肠可显著减少腹腔引流量及引流管留置时间;可促进患者胃肠道功能的恢复以及缩短术后住院时间,有助于促进患者术后排气排便,降低术后近期并发症。
