直肠癌患者腹腔镜、机器人辅助和经肛门全肠系膜切除术的短期和长期结果比较：倾向评分匹配分析

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-08-18 DOI:10.1007/s10151-025-03204-5

G-Y Chen, C-K Liao, J-F You, C-C Lai, S-H Huang

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引用次数: 0

摘要

背景：全肠系膜切除（TME）仍然是直肠癌手术的肿瘤学标准；然而，低位直肠癌的微创治疗仍然存在技术挑战。经肛门TME （TaTME）和机器人TME是为了克服腹腔镜TME在狭窄骨盆空间中的局限性而开发的。尽管结果令人鼓舞，但这些方法之间的比较证据仍然有限且不一致。为了解决这一差距，我们进行了倾向评分匹配分析，以评估和比较TaTME、机器人TME和腹腔镜TME在大容量三级中心治疗的直肠癌患者的临床和肿瘤学结果。方法：本回顾性研究纳入了2015年至2021年间接受恢复性直肠切除术的直肠癌患者。倾向评分匹配用于平衡三组的人口统计学、临床和治疗变量。采用标准统计方法对结果进行分析。结果：匹配后纳入240例患者（40例TaTME， 40例机器人TME， 160例腹腔镜TME）。TaTME和机器人TME的总并发症发生率明显低于腹腔镜TME（27.5%比20.0%比39.4%,p = 0.033）。腹腔镜组环切缘阳性率最高（10.6% vs 0% vs 2.5%, p = 0.031）。然而，5年总生存率（82.5%比85.0%比88.1%,p = 0.251）、无病生存率（75.0%比72.5%比73.8%,p = 0.772）、局部复发（17.5%比12.5%比24.7%,p = 0.488）和远端转移（17.5%比22.5%比25.2%,p = 0.694）在组间无显著差异。结论：所有三种微创TME技术取得了相当的长期肿瘤预后。手术入路应根据外科医生的专业知识和患者的具体因素进行调整。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Comparison of short- and long-term outcomes among laparoscopic, robotic-assisted, and transanal total mesorectal excision procedures in patients with rectal cancer: a propensity score-matching analysis.

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Background: Total mesorectal excision (TME) remains the oncologic standard for rectal cancer surgery; however, technical challenges persist in the minimally invasive treatment of low rectal cancer. Transanal TME (TaTME) and robotic TME were developed to overcome the limitations of laparoscopic TME in confined pelvic spaces. Despite promising results, comparative evidence among these approaches remains limited and heterogeneous. To address this gap, we conducted a propensity score-matched analysis to evaluate and compare the clinical and oncologic outcomes of TaTME, robotic TME, and laparoscopic TME in patients with rectal cancer treated at a high-volume tertiary center.

Methods: This retrospective study included patients with rectal cancer who underwent restorative proctectomy between 2015 and 2021. Propensity score matching was used to balance demographic, clinical, and treatment variables across the three groups. Outcomes were analyzed using standard statistical methods.

Results: After matching, 240 patients were included (40 TaTME, 40 robotic TME, and 160 laparoscopic TME). TaTME and robotic TME demonstrated significantly lower overall complication rates than laparoscopic TME (27.5% versus 20.0% versus 39.4%, p = 0.033). The circumferential resection margin positivity rate was highest in the laparoscopic group (10.6% versus 0% versus 2.5%, p = 0.031). However, 5-year overall survival (82.5% versus 85.0% versus 88.1%, p = 0.251), disease-free survival (75.0% versus 72.5% versus 73.8%, p = 0.772), local recurrence (17.5% versus 12.5% versus 24.7%, p = 0.488), and distal metastasis (17.5% versus 22.5% versus 25.2%, p = 0.694) did not significantly differ among groups.

Conclusions: All three minimally invasive TME techniques achieved comparable long-term oncologic outcomes. Surgical approach should be tailored on the basis of surgeon expertise and patient-specific factors.

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.