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  • Title: [Comparison of short-term outcomes of robotic and laparoscopic surgery for mid-low rectal cancer: a propensity matched analysis].
    Author: Li RQ, Zhou JJ, Zhao S, Wang DR.
    Journal: Zhonghua Wei Chang Wai Ke Za Zhi; 2024 Dec 25; 27(12):1261-1268. PubMed ID: 39710453.
    Abstract:
    Objective: To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer. Methods: This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients. Results: (1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant (P=0.230 for DFS, P=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ2 = 6.712; P = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both P > 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, t =8.965, P=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, t = =3.851, P = 0.010), urinary tract complications (mean score 17.5±1.5 vs. 23.4±1.6, t = 41.40, P =0.001), and gastrointestinal symptoms (mean score 21.2±2.1 vs. 26.6±1.9, t = 29.40, P =0.001). These differences are all statistically significant (all P <0.05). By 12 months postoperatively, there were no statistically significant differences in functional or symptom modules of quality-of-life between the two groups (both P >0.05). (4) Perioperative complications: There was no statistically significant difference in intraoperative complications between the two groups (P > 0.05). The incidence of postoperative urinary retention was significantly higher in the laparoscopic than the robotic group (5.0% [19/350] vs. 1.7% [3/175], χ2 = 4.009, P = 0.044). Conclusion: In our study, robotic radical surgery for rectal cancer achieved short-term oncological outcomes similar to those achieved by laparoscopic radical surgery for rectal cancer. However, robotic radical surgery had advantages in terms of anal function and postoperative quality of life, while also reducing the incidence of perioperative urinary complications. 目的： 探讨机器人与腹腔镜手术治疗中低位直肠癌的短期疗效。 方法： 本研究采用回顾性队列研究方法，纳入2019年7月至2021年11月期间在南京大学附属苏北人民医院采用腹腔镜或机器人行直肠癌根治术治疗的中低位直肠癌（肿瘤下缘距肛缘<10 cm）患者临床资料，排除未能完全保留肛门、癌性梗阻或穿孔、术前低位前切除综合征（LARS）评分显示肛门功能差以及随访资料不完整的患者。共973例符合标准纳入研究。为减少基线不平衡时患者之间的偏差，采用1∶2最近邻匹配法进行倾向评分匹配，机器人组175例，腹腔镜组350例；两组基线资料的比较，差异无统计学意义。主要观察指标为两组肿瘤学预后［无病生存率（DFS）和总体生存率（OS）］和肛门功能（术后6个月和12个月采用LARS评分系统进行评估）的比较。次要观察指标为患者术后生活质量（根据生命质量测定量表QLQ-C30及QLQ-CR38来建立新的量表，于术后6个月和12个月进行评估；功能模块评分越高，表示患者功能越好，而体征模块评分越低，表示症状越轻）以及患者围手术期相关并发症发生率的比较。 结果： （1）肿瘤学预后：机器人组术后2年DFS和OS分别89.7%和93.1%；腹腔镜组分别为86.0%和91.7%。两组比较，差异均无统计学意义（分别：P=0.230，P=0.570）。（2）肛门功能：未行回肠造口患者中，机器人组术后6个月的肛门功能优于腹腔镜组［重度LARS：9.8%（14/143）比19.2%（56/292），χ2=6.712；P=0.035］；而在术后12个月时，两组患者差异无统计学意义。施行回肠造口的患者中，两组术后6个月和12个月肛门功能差异均无统计学意义（均P>0.05）。（3）术后生活质量：与腹腔镜组比较，机器人组的生活能力［（77.1±6.9）分比（71.7±5.6）分，t=8.965，P=0.005］、工作社交能力［（73.4±5.3）分比（71.6±5.1）分，t=3.851，P=0.010］、排尿问题［（17.5±1.5）分比（23.4±1.6）分，t=41.40，P=0.001］以及胃肠道症状方面［（21.2±2.1）分比（26.6±1.9）分，t=29.40，P=0.001］更具优势，差异均有统计学意义（均P<0.05）。在术后12个月时，两组功能和体征模块的生活质量差异均无统计学意义（均P>0.05）。（4）围手术期并发症：两组术中并发症的差异均无统计学意义（均P>0.05）；腹腔镜组患者术后尿潴留的发生率高于机器人组［5.0%（19/350）比1.7%（3/175），χ2=4.009，P=0.044］，差异有统计学意义。 结论： 机器人直肠癌根治术可以达到与腹腔镜直肠癌根治术相似的短期肿瘤学结果，并在肛门功能和术后生活质量上具有优势，同时可降低围手术期泌尿系统并发症发生率。.
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