Comparison of short-term outcomes between robot-assisted versus laparoscopic intersphincteric resection for low rectal cancer

doi:10.3877/cma.j.issn.2095-3224.2019.05.008

Abstract

Abstract:

Objective

To compare the short-term efficacy of robotic and laparoscopic sphincterotomy for low rectal cancer and to investigate the safety and feasibility of robotic sphincterotomy.

Methods

The characteristics of patients underwent robot-assisted or laparoscopic intersphincteric resection for low rectal cancer were retrospectively collected from October 2015 to October 2017 in Gansu Provincial Hospital. Compared the operative time, intraoperative blood loss, intraoperative laparotomy, first ventilation time, postoperative hospital stays, complications, distance from the distant margin of the tumor, number of positive circumferential resection margins, number of lymph nodes removed, and other outcoms between two groups.

Results

The liquid diet time, first ventilation time and postoperative hospital stays of the robot group were shorter than the laparoscopic group (P<0.05). The intraoperative blood loss in the robot group was more than the laparoscopic group (P<0.05). There were no significant difference between two groups in postoperative complications or operation time. The total cost of the robotic group was higher than the laparoscopic group (P<0.001).

Conclusions

Robotic sphincterotomy for low rectal cancer is safe and feasible. Compared with laparoscopic surgery, the robotic surgery had rapider recovery of bowel function, shorter hospital stays, and more reliable short-term efficacy in oncology. Robotic sphincterotomy may be an effective treatment for the low rectal cancer.

Key words: Rectal neoplasms, Robotic surgery, Laparoscopy surgery, Intersphincteric resection

Xiaolong Zhu, Peijing Yan, Liang Yao, Yulong Wang, Wenhan Liu, Binbin Du, Kehu Yang, Tiankang Guo, Xiongfei Yang. Comparison of short-term outcomes between robot-assisted versus laparoscopic intersphincteric resection for low rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(05): 480-485.

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Figures/Tables 6

References 29

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组别	年龄（岁）				性别		BMI（kg/m²）			距肛缘的距离（cm）	癌胚抗原（ng）
组别	<54	54~61	62~67	>67	男	女	<18.5	18.5~23.9	>24	距肛缘的距离（cm）	癌胚抗原（ng）
机器人组	8（21.6）	7（18.9）	11（29.7）	11（29.7）	27（73.0）	10（27.0）	3（8.1）	18（48.7）	16（43.2）	4.54±1.24	3.01（1.81~5.67）^*
腹腔镜组	14（26.9）	16（30.8）	12（23.1）	10（19.2）	38（73.1）	14（26.9）	6（11.5）	33（63.5）	13（25.0）	4.37±1.17	3.30（1.88~10.77）^*
t/χ²值	2.801				0.000		2.989			0.679	-
P值	0.423				0.991		0.224			0.499	0.200

组别	年龄（岁）				性别		BMI（kg/m²）			距肛缘的距离（cm）	癌胚抗原（ng）
组别	<54	54~61	62~67	>67	男	女	<18.5	18.5~23.9	>24	距肛缘的距离（cm）	癌胚抗原（ng）
机器人组	8（21.6）	7（18.9）	11（29.7）	11（29.7）	27（73.0）	10（27.0）	3（8.1）	18（48.7）	16（43.2）	4.54±1.24	3.01（1.81~5.67）^*
腹腔镜组	14（26.9）	16（30.8）	12（23.1）	10（19.2）	38（73.1）	14（26.9）	6（11.5）	33（63.5）	13（25.0）	4.37±1.17	3.30（1.88~10.77）^*
t/χ²值	2.801				0.000		2.989			0.679	-
P值	0.423				0.991		0.224			0.499	0.200

组别	手术时间（min）	失血量（ml）	输血量（ml）	中转率	流质饮食时间（天）	排气时间（天）	引流量（ml）	放置引流管时间（tian）	术后住院时间（天）
机器人组	210.00±62.47	200.00（100.00~300.00）^*	0.00±0.00	1（2.7）	4.27±1.41	2.00±0.83	200.00（15.00~525.00）^*	7.38±2.53	9（7~12）^*
腹腔镜组	214.81±65.00	100.00（60.00~100.00）^*	5.77±4.16	3（5.8）	6.87±2.77	4.48±1.28	365.00（112.50~760.00）^*	7.88±3.27	13（10~19）^*
t/χ²值	-0.381	-	-4.213	0.474	-5.234	-11.01	-	-0.788	-
P值	0.704	0.005	0.402	0.491	<0.001	<0.001	0.061	0.433	0.001

组别	手术时间（min）	失血量（ml）	输血量（ml）	中转率	流质饮食时间（天）	排气时间（天）	引流量（ml）	放置引流管时间（tian）	术后住院时间（天）
机器人组	210.00±62.47	200.00（100.00~300.00）^*	0.00±0.00	1（2.7）	4.27±1.41	2.00±0.83	200.00（15.00~525.00）^*	7.38±2.53	9（7~12）^*
腹腔镜组	214.81±65.00	100.00（60.00~100.00）^*	5.77±4.16	3（5.8）	6.87±2.77	4.48±1.28	365.00（112.50~760.00）^*	7.88±3.27	13（10~19）^*
t/χ²值	-0.381	-	-4.213	0.474	-5.234	-11.01	-	-0.788	-
P值	0.704	0.005	0.402	0.491	<0.001	<0.001	0.061	0.433	0.001

组别	肿瘤大小（cm²）	淋巴结数	阳性淋巴结数	术后AJCC分期
组别	?	?	?	0	Ⅰ	Ⅱ	Ⅲ
机器人组	7.50（3.49~17.06）*	10.81±5.09	0±2	0（0.0）	8（21.6）	17（45.9）	12（32.4）
腹腔镜组	12.00（5.00~17.50）*	12.92±5.30	0±3	1（1.9）	13（25.0）	17（32.7）	21（40.4）
t/χ²值	-	-1.866	-2.15	2.179
P值	0.180	0.065	0.034	0.536
组别	组织学分类			距远端距离（cm）	病理诊断结果		环周切缘阳性
组别	高分化	中分化	其他	距远端距离（cm）	腺癌	其他	环周切缘阳性
机器人组	3（8.1）	30（81.0）	4（18.9）	1.5±0.5	37（100）	0（0.0）	2（5.4）
腹腔镜组	2（3.8）	47（90.4）	3（5.7）	1.3±0.4	49（94.2）	3（5.8）	3（5.7）
t/χ²值	4.084			2.966	2.209		0.005
P值	0.130			0.004	0.137		0.941

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