Robotic Versus Laparoscopic Partial Mesorectal Excision for Cancer of the High Rectum: A Single-Center Study with Propensity Score Matching Analysis

被引:10
|
作者
de'Angelis, Nicola [1 ,2 ]
Notarnicola, Margerita [1 ]
Martinez-Perez, Aleix [3 ]
Memeo, Riccardo [4 ]
Charpy, Cecile [5 ]
Urciuoli, Irene [1 ]
Maroso, Fabio [1 ]
Sommacale, Daniele [1 ]
Amiot, Aurelien [2 ,6 ]
Canoui-Poitrine, Florence [7 ,8 ]
Levesque, Eric [9 ,10 ]
Brunetti, Francesco [1 ]
机构
[1] Univ Paris Est, Henri Mondor Hosp, AP HP,UPEC, Unit Digest Hepatopancreatobiliary Surg & Liver T, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
[2] Univ Paris Est, EA7375, Res Team EC2M3, 51 Ave Marechal Lattre de Tassigny, F-94000 Creteil, France
[3] Hosp Univ Doctor Peset, Unit Colorectal Surg, Dept Gen & Digest Surg, 90 Av Gaspar Aguilar, Valencia 46017, Spain
[4] Univ Aldo Moro Bari, Dept Emergency & Organ Transplantat, Piazza Umberto I 1, I-70121 Bari, Italy
[5] Henri Mondor Hosp, AP HP, Dept Pathol, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
[6] Henri Mondor Hosp, AP HP, Dept Gastroenterol, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
[7] Henri Mondor Hosp, AP HP, Dept Publ Hlth L, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
[8] Univ Paris Est, Creteil UPEC, IMRB, CEPiA,INSERM,U955, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
[9] Univ Paris Est, Henri Mondor Hosp, AP HP, Dept Anesthesia, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
[10] Univ Paris Est, Henri Mondor Hosp, AP HP, Liver Intens Care Unit, 51 Ave Marechal Lattre de Tassigny, F-94010 Creteil, France
关键词
LOW ANTERIOR RESECTION; COLORECTAL-CANCER; OPEN SURGERY; OUTCOMES; TRIAL; STOMA; MANAGEMENT; DISTAL; MARGIN; COHORT;
D O I
10.1007/s00268-020-05666-0
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (R-PME) versus laparoscopic (L-PME) PME for high RC. Methods This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum (>10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019. Results Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PME patients, except for operative time (220 min and 190 min, respectively;p < 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME. Conclusion Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon's experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC.
引用
收藏
页码:3923 / 3935
页数:13
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