A National Cancer Database Analysis of the Trends in Conversion from Robotic-Assisted Proctectomy to Laparotomy in Rectal Cancer.

IF 1.1 4区 医学 Q3 SURGERY
Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Ebram Salama, Steven D Wexner
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Abstract

Background: Robotic-assisted proctectomy (RAP) has been reportedly associated with lower rates of conversion to laparotomy than laparoscopy in several cohort studies. This st0udy aimed to assess the temporal trends in conversion from RAP to laparotomy stratified by patient and treatment-related factors. Methods: This retrospective observational study was undertaken to analyse the temporal trends in unplanned conversion from RAP to laparotomy. Changes in the rates of conversion over time were plotted as line graphs, and the significance of each trend was calculated with the Cochran-Armitage trend test. A case-control analysis of factors associated with conversion to open surgery was conducted. Results: The study included 23,644 patients (62.3% male, median age: 60 years). 1280 (5.4%) patients were converted to laparotomy. There was a significant linear trend of decreased conversion over time (3.9% in 2021 compared with 10.4% in 2010; P < .001). The reduction in conversion rates was significant in all patients except in patients <50 years (P = .838), Black patients (P = .358), patients with a Charlson comorbidity index score >1 (P = .053), patients with governmental insurance other than Medicaid and Medicare (P = .629), and patients undergoing abdominoperineal resection (APR) (P = .129) or pelvic exenteration (PE) (P = .326). The independent predictors for increased conversion were male sex, higher Charlson scores, community cancer programs, comprehensive community cancer programs, household income of <$63,000, tumors ≥5 cm, and PE. Conclusions: Unplanned conversion from RAP to laparotomy showed a linear trend of reduction over time, which was statistically significant except in young patients, Black patients, patients with significant comorbidities, and patients undergoing APR or PE.

一个国家癌症数据库分析在直肠癌中从机器人辅助直肠切除术到剖腹手术的转变趋势。
背景:据报道,在几项队列研究中,机器人辅助直肠切除术(RAP)与剖腹手术的转换率比腹腔镜手术低。本研究旨在评估从RAP到剖腹手术的时间趋势,并按患者和治疗相关因素分层。方法:本回顾性观察研究旨在分析从RAP到剖腹手术的非计划转换的时间趋势。转化率随时间的变化被绘制成线形图,每个趋势的显著性用Cochran-Armitage趋势检验计算。对转开手术相关因素进行病例-对照分析。结果:研究纳入23644例患者,其中男性62.3%,中位年龄60岁。1280例(5.4%)患者转为剖腹手术。随着时间的推移,转化率呈显著的线性下降趋势(2021年为3.9%,2010年为10.4%;P < 0.001)。除P = 0.838、黑人患者(P = 0.358)、Charlson合病指数评分为bb0.1的患者(P = 0.053)、除医疗补助和医疗保险外有政府保险的患者(P = 0.629)和接受腹外阴部切除术(P = 0.129)或盆腔切除(P = 0.326)的患者外,所有患者的转归率均显著降低。转换增加的独立预测因子为男性、较高的Charlson评分、社区癌症项目、综合社区癌症项目、家庭收入。结论:从RAP到剖腹手术的非计划转换随时间呈线性下降趋势,除了年轻患者、黑人患者、有显著合并症的患者和接受APR或PE的患者外,统计学意义显著。
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
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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