机器人与腹腔镜直肠癌根治术治疗超重和肥胖患者的疗效对比分析

目的在肥胖直肠癌患者的腹腔镜盆腔手术操作中,常因腹腔大量脂肪堆积,影响手术视野暴露,技术难度较大。相比之下,机器人手术具备更加微创、精准、灵活的优势。本研究比较机器人与腹腔镜直肠癌根治术治疗超重和肥胖患者的临床疗效。方法采用回顾性队列研究方法。收集2015年1月至2019年2月期间,在南昌大学第一附属医院接受机器人或腹腔镜直肠癌根治术的173例体质指数≥25 kg/m²直肠癌患者的临床资料。90例行机器人直肠癌根治术(机器人手术组),83例行腹腔镜直肠癌根治术(腹腔镜手术组)。比较两组术中、术后短期情况和随访情况。随访截止时间为2019年12月。结果173例患者中男性103例,女性70例,中位年龄62(29~86)岁。两组患者一般资料比较差异均无统计学意义(均P>0.05)。与腹腔镜手术组相比,机器人手术组术中出血量少(73.0±46.8)ml比(120.9±59.9)ml,t=-5.881,P<0.001],术后住院费用高于腹腔镜手术组(6.1±1.5)万元比(5.2±1.3)万元,t=3.468,P=0.026];机器人手术组中转开腹率为1.1%(1/90),低于腹腔镜手术组6.0%(5/83),但差异无统计学意义(P=0.106)。两组手术时间、术中输血例数、淋巴结清扫数目、术后通气时间、术后住院天数和术后总并发症发生率差异均无统计学意义(均P>0.05)。腹腔镜手术组中5例(6.0%)术后出现排尿功能障碍,而机器人手术组无术后排尿功能障碍发生,两组差异有统计学意义(P=0.024)。173例患者术后中位随访36(8~59)个月,机器人手术组和腹腔镜手术组3年总体生存率分别为89.8%和86.6%,差异无统计学意义(P=0.615);3年无复发生存率分别为85.6%和81.5%,差异无统计学意义(P=0.638)。结论机器人根治性手术治疗超重和肥胖直肠癌患者安全可行,与腹腔镜手术相比,术野暴露更清晰,术中出血更少,可改善神经保护,在盆腔狭小的空间操作具有一定的优势,且远期疗效相当。

Efficacy comparison of robotic and laparoscopic radical resection of rectal cancer for overweight and obese patients

Objective During laparoscopic pelvic operational procedure for obese patients with rectal cancer,the large amount of fat in the abdominal cavity often impairs the exposure of the surgical field,resulting in technical difficulty.In contrast,robotic surgery has the advantages of being more minimally invasive,precise,and flexible.This study compared the clinical efficacy of robotic and laparoscopic radical resection of rectal cancer for overweight and obese patients.Methods A retrospective cohort study was conducted.Clinical data of 173 patients with rectal cancer and a body mass index(BMI)≥25 kg/m² who received robotic or laparoscopic radical rectal resection at the First Affiliated Hospital of Nanchang University from January 2015 to February 2019 were retrospectively collected.Of 173 patients,90 underwent robotic surgery and 83 underwent laparoscopic surgery.The intraoperative parameters,postoperative short-term and follow-up status were analyzed and compared between the two groups.The follow-up ended in December 2019.Results Of 173 patients,103 were male and 70 were female with a median age of 62(range 29 to 86)years.The average BMI was(27.2±1.6)kg/m² in the robotic group and(27.3±1.5)kg/m² in the laparoscopic group.No significant differences in baseline data were observed between two groups(all P>0.05).As compared to the laparoscopic group,the robotic group had less intraoperative blood loss(73.0±46.8)ml vs.(120.9±59.9)ml,t=-5.881,P<0.001]and higher postoperative hospitalization expense(61±15)thousand yuan vs(52±13)thousand yuan,t=3.468,P=0.026].The conversion rate in the robotic group was 1.1%(1/90),which was lower than 6.0%(5/83)in the laparoscopic group,but the difference was not statistically significant(P=0.106).There were no statistically significant differences between the two groups in operative time,number of intraoperative blood transfusion,number of harvested lymph nodes,time to the first flatus,postoperative hospital stay and morbidity of total postoperative complications(all P>0.05).Five(6.0%)patients in the laparoscopic group developed urinary dysfunction,while no case in the robotic group developed postoperative urinary dysfunction(P=0.024).The 173 patients were followed up for 8-59 months,with a median follow-up of 36 months.The 3-year overall survival rate of robotic group and laparoscopic group was 89.8%and 86.6%,respectively without significant difference between the two groups(P=0.638).The 3-year disease-free survival rate of the robotic group and the laparoscopic group was 85.6%and 81.5%,respectively without significant difference as well(P=0.638).Conclusions Robotic radical surgery is safe and feasible for overweight and obese patients with rectal cancer.Compared with laparoscopic radical surgery,it has advantages of clear vision of surgical exposure,less intraoperative blood loss,less pelvic autonomic nerve damage,and operation in a narrow space.