Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae044
Nicola de'Angelis, Francesco Marchegiani, Aleix Martínez-Pérez, Alberto Biondi, Salvatore Pucciarelli, Carlo Alberto Schena, Gianluca Pellino, Miquel Kraft, Annabel S van Lieshout, Luca Morelli, Alain Valverde, Renato Micelli Lupinacci, Segundo A Gómez-Abril, Roberto Persiani, Jurriaan B Tuynman, Eloy Espin-Basany, Frederic Ris
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Abstract

Background: Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME).

Methods: Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival.

Results: A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival.

Conclusion: In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.

局部晚期中/低位直肠癌的机器人、经肛门和腹腔镜全直肠系膜切除术:欧洲多中心倾向评分匹配研究。
背景:全直肠系膜切除术(TME)是低位/中位局部晚期直肠癌的标准手术。本研究的目的是比较三种带主吻合器的 TME 微创手术方法(腹腔镜 TME、机器人 TME 和经肛门 TME):分析了2013年至2022年期间在欧洲核磁共振和直肠癌手术III(EuMaRCS-III)数据库的专家中心根据标准化技术接受腹腔镜TME、机器人TME或经肛门TME手术的患者记录。采用倾向评分匹配法对三组患者的并发症发生率(主要结果)、转归率、术后恢复和生存率进行了比较:共纳入468名患者(平均(s.d.)年龄为64.1(11)岁),其中190名(40.6%)患者接受了腹腔镜TME,141名(30.1%)患者接受了机器人TME,137名(29.3%)患者接受了经肛门TME。倾向得分匹配后的比较分析表明,与机器人TME(OR 1.80,95% c.i.1.11-2.91)和经肛门TME(OR 2.87,95% c.i.1.72-4.80)相比,腹腔镜TME的术后并发症发生率更高。与腹腔镜 TME(8.8%)和经肛门 TME(8.1%)相比,机器人 TME 的 A 级吻合口漏率较低(2%)(P = 0.031)。与腹腔镜TME(8.8%)相比,机器人TME(1.4%)和经肛门TME(0.7%)转为开腹手术的比例都较低(P < 0.001)。接受经肛门 TME 治疗的患者排便时间和住院时间更短(P = 0.003 和 0.001)。手术时间、术中并发症、失血量、死亡率、再入院率、R0切除率或存活率均无差异:在这项针对局部晚期直肠癌患者的多中心、回顾性、倾向评分匹配队列研究中,较新的微创方法(机器人TME和经肛门TME)与腹腔镜TME相比,疗效更佳。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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