Influence of surgical start time on the quality of surgery for middle and low rectal cancer: a post hoc analysis of the real trial.

IF 12.5 2区 医学 Q1 SURGERY
Guodong He, Zhang Zhuojian, Weitang Yuan, Taiyuan Li, Bo Tang, Baoqing Jia, Yanbing Zhou, Wei Zhang, Ren Zhao, Cheng Zhang, Longwei Cheng, Xiaoqiao Zhang, Fei Liang, Ye Wei, Qingyang Feng, Jianmin Xu
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引用次数: 0

Abstract

Background: Surgical start time is considered to influence the quality of surgery due to surgeon fatigue. High-quality studies on middle and low rectal cancer are lacking. The analysis aims to find out the influence of surgical start time on the quality of surgery for middle and low rectal cancer, and whether robotic surgery could avoid the influence.

Materials and methods: This study was a post hoc analysis of the REAL (robotic vs. laparoscopic surgery for middle and low rectal cancer) study, a multicenter, randomized, controlled, unblinded, parallel group, superiority trial. This analysis included the modified intention-to-treat population of the REAL study, who were divided into Group I (the surgeon's first surgery of the day), Group II (the surgeon's second surgery of the day), and Group III (the surgeon's third and subsequent surgeries of the day) based on surgical information registered in the REAL study. The primary outcome was the percentage of patients with a positive circumferential resection margin. The second outcomes were the macroscopic completeness of resection the incidence of intraoperative complications and 30-day postoperative complications.

Results: A total of 1171 patients from the REAL study were included and divided into three groups: 547 (46.7%) in Group I (the surgeon's first surgery), 420 (35.9%) in Group II (the surgeon's second surgery), and 204 (17.4%) in Group III (the surgeon's third and subsequent surgeries). There was a lower percentage of circumferential resection margin (CRM)-positive patients in Group I (3.9%) than in Group II (6.6%, unadjusted P = 0.069) and Group III (8.1%, unadjusted P = 0.027, adjusted P = 0.081). Group I also had fewer intraoperative complications (5.3%) than Group II (8.3%, unadjusted P = 0.060) and Group III (9.3%, unadjusted P = 0.046, adjusted P = 0.138). Macroscopic completeness of resection was not significantly different among the three groups (complete rate: Group I vs. Group II, 94.9% vs. 92.4%, unadjusted P = 0.254; Group I vs. Group III, 94.9% vs. 92.6%, unadjusted P = 0.334; Group II vs. Group III, 92.4% vs. 92.6%, unadjusted P = 0.488). The incidence of 30-day postoperative complications showed no significant difference among the three groups (Group I vs. Group II, 18.5% vs. 20.0%, unadjusted P = 0.547; Group I vs. Group III, 18.5% vs. 22.1%, unadjusted P = 0.268; Group II vs. Group III, 20.0% vs. 22.1%, unadjusted P = 0.551). The quality of robotic surgery was not significantly influenced by surgical start time. For laparoscopic surgery, Group I had a lower CRM positivity rate (4.3%) than Group II (9.4%, unadjusted P = 0.029, adjusted P = 0.087) and Group III (10.4%, unadjusted P = 0.031, adjusted P = 0.047).

Conclusion: According to this post hoc analysis of the REAL study, for middle and low rectal cancer surgery, surgical start time could influence surgical quality by affecting surgeon fatigue. Surgeries start later in a day bring worse quality compared to those early in a day. Robotic surgery could reduce this influence to some extent, while laparoscopic surgery is more susceptible.

手术开始时间对中低位直肠癌手术质量的影响:一项真实试验的事后分析
背景:手术开始时间被认为是影响手术质量的重要因素。目前缺乏关于中低位直肠癌的高质量研究。本分析旨在了解手术开始时间对中低位直肠癌手术质量的影响,以及机器人手术是否可以避免这种影响。材料和方法:本研究是REAL(机器人与腹腔镜手术治疗中低位直肠癌)研究的事后分析,REAL是一项多中心、随机、对照、非盲、平行组、优势试验。该分析包括REAL研究中修改后的意向治疗人群,根据REAL研究中登记的手术信息,将其分为I组(外科医生当天的第一次手术)、II组(外科医生当天的第二次手术)和III组(外科医生当天的第三次及后续手术)。主要结果是周切缘阳性患者的百分比。第二个结果是手术切除的宏观完全性、术中并发症和术后30天并发症的发生率。结果:REAL研究共纳入1171例患者,分为三组:I组(第一次手术)547例(46.7%),II组(第二次手术)420例(35.9%),III组(第三次及后续手术)204例(17.4%)。与对照组(6.6%,未校正P = 0.069)和对照组(8.1%,未校正P = 0.027,校正P = 0.081)相比,对照组(3.9%)外周血环切缘(CRM)阳性患者比例较低。I组术中并发症发生率(5.3%)低于II组(8.3%,未校正P = 0.060)和III组(9.3%,未校正P = 0.046,校正P = 0.138)。三组间宏观切除的完成度无显著差异(完成率:I组vs. II组,94.9% vs. 92.4%,未经调整P = 0.254;I组vs. III组,94.9% vs. 92.6%,未经校正P = 0.334;II组vs. III组,92.4% vs. 92.6%,未经校正P = 0.488)。三组术后30天并发症发生率差异无统计学意义(I组vs. II组,18.5% vs. 20.0%,未经校正P = 0.547;I组vs. III组,18.5% vs. 22.1%,未经校正P = 0.268;II组vs. III组,20.0% vs. 22.1%,未经校正P = 0.551)。手术开始时间对机器人手术质量影响不显著。腹腔镜手术中,I组的CRM阳性率(4.3%)低于II组(9.4%,未调整P = 0.029,调整P = 0.087)和III组(10.4%,未调整P = 0.031,调整P = 0.047)。结论:根据REAL研究的事后分析,对于中低位直肠癌手术,手术开始时间可以通过影响外科医生的疲劳来影响手术质量。晚些时候开始的手术比早些开始的手术质量更差。机器人手术可以在一定程度上减少这种影响,而腹腔镜手术更容易受到影响。
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
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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