机器人与腹腔镜手术治疗肥胖中低位直肠癌患者短期疗效比较

李森; 薛勇敢; 柯沐; 黄埔; 邝衍绅; 孟庆禹; 宁伯彬; 王文琛; 刘唯正; 滕志鹏; 李鹏; 刘洪一; 贾宝庆

doi:10.3969/j.issn.2095-5227.2023.06.009

机器人与腹腔镜手术治疗肥胖中低位直肠癌患者短期疗效比较

Evaluation of short-term outcomes of robotic versus laparoscopic surgery in obese patients with mid-low rectal cancer

摘要

摘要:
背景由于腹腔镜器械存在自由度低等固有缺点，其在肥胖中低位直肠癌患者中应用受限。而机器人手术相较于腹腔镜在此类人群中应用是否具有优势仍然未知。
目的比较机器人与腹腔镜手术治疗肥胖中低位直肠癌患者的短期疗效。
方法回顾性分析2017年2月 - 2022年8月解放军总医院第一医学中心普通外科五病区收治的肥胖中低位直肠癌患者的临床资料，根据手术治疗设备将患者分为机器人组和腹腔镜组，以倾向性评分匹配(propensity score matching，PSM)对两组患者基线资料进行1∶1匹配后比较两组结局指标，评价两种手术方式的短期疗效，应用单因素和多因素logistic回归分析并发症发生的影响因素。
结果本研究共纳入207例患者，其中机器人组108例，腹腔镜组99例。PSM后两组患者各为66例。机器人组的环周切缘阳性率(4.5% vs 15.2%，P=0.041)及术后30 d内并发症发生率(7.6% vs 22.7%，P=0.015)均低于腹腔镜组，差异有统计学意义。多因素logistic回归分析提示使用机器人手术系统有助于降低术后30 d内并发症发生率(OR：0.269，95% CI：0.090 ~ 0.804，P=0.019)。
结论与腹腔镜手术相比，机器人手术有助于降低肥胖中低位直肠癌患者术后环周切缘阳性率和术后30 d内并发症发生率，在改善短期疗效方面具有一定优势。

Abstract:
Background Due to the inherent disadvantages of laparoscopic instruments such as the loss of several degrees of freedom, their applications in the treatment of mid-low rectal cancer in obese patients are limited. However, the definitive outperformance of the robotic system versus laparoscopic procedure when treating mid-low rectal cancer in the obese population remains to be determined.
Objective To evaluate the short-term outcomes of robotic versus laparoscopic surgery in obese patients with mid-low rectal cancer.
Methods Clinical data about obese patients with mid-low rectal cancer admitted to the Fifth Ward of the General Surgery Department in the First Medical Center of Chinese PLA General Hospital from February 2017 to August 2022 were retrospectively analyzed. According to the surgical procedure, the patients were divided into robotic group and laparoscopic group. After performing propensity score matching (PSM) of the baseline characteristics of the two groups, the indicators were compared to evaluate the short-term outcomes. Univariate and multivariate logistic regression were used to analyze the influencing factors of the occurrence of complications.
Results A total of 207 cases were screened for this study, including 108 cases in the robotic group and 99 cases in the laparoscopic group. After PSM, there were 66 patients in each group. The positive rate of circumferential incision margin (4.5% vs 15.2%, P=0.041) and the incidence of complications within 30 days after surgery (7.6% vs 22.7%, P=0.015) reduced significantly in the robotic group when compared to the laparoscopic group. Multivariate logistic regression analysis suggested that robotic surgery could reduce the incidence of complications within 30 days after surgery (OR: 0.269, 95%CI: 0.090-0.804, P=0.019).
Conclusion Compared with laparoscopic surgery, robotic surgery contributes to reducing the positive rate of circumferential resection margin and the incidence of complications within 30 days after surgery in obese patients with mid-low rectal cancer, and has certain advantages in improving short-term outcomes.

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