机器人辅助多脏器切除在治疗结直肠癌中的应用
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摘要
目的探讨机器人辅助多脏器切除治疗结直肠癌的安全性及可行性。方法回顾分析2014年11月至2017年12月吉林省肿瘤医院收治的13例结直肠患者的临床资料,选择机器人辅助联合多脏器切除术作为治疗策略。分析患者的一般资料、手术结果及肿瘤学结果。结果全组患者中男7例、女6例,中位年龄60岁,其中直肠癌5例、乙状结肠癌8例;行整块切除7例,联合肝部分切除2例、小肠部分切除3例、子宫切除3例、卵巢切除4例、膀胱及输尿管部分切除1例、右半结肠切除1例。全组中位手术时间为225 min(90~360 min)、中位出血量50 ml(15~600 ml),无术中输血。全组共中转手术5例,其中计划性中转手术3例、非计划性中转手术2例。所有患者均达到R0切除,无围手术期死亡,发生术后并发症2例。结论机器人辅助多脏器切除治疗结直肠癌是安全、可行的。
Objective To assess the safety and feasibility of robotic-assisted multivisceral resection for advanced colorectal cancer. Methods From Nov. 2014 to Dec. 2017, patients who underwent robotic-assisted multivisceral resection for colorectal cancer were investigated. Patient demographics,treatment characteristics,perioperative outcomes,and pathological results were evaluated retrospectively.Results There were 13 patients; 7 men and 6 women,with a median age of 60 years. 5 patients had rectal cancer,8 patients had sigmoid cancer,7 patients had a c T4 b tumor,and underwent complete resection of the primary tumor. The resected organ were the part of liver( n = 2),small intestine( n = 3),uterus( n =3),ovary( n = 4),bladder with ureter( n = 1) and right-side colon( n = 1). The median operative time was225 min( range 90-360 min),and the median blood loss was 50 ml( range 15-600 ml). None of the patients received intra-operative blood transfusions. There were 5 patients required conversion,3 patients were planned,2 were unplanned. All patients were R0 resection,and no peri-operative death occurred.Postoperative complications occurred in 2 patients. Conclusions Robotic-assisted multivisceral resection for colorectal cancer is safe and technically feasible.
Objective To assess the safety and feasibility of robotic-assisted multivisceral resection for advanced colorectal cancer. Methods From Nov. 2014 to Dec. 2017, patients who underwent robotic-assisted multivisceral resection for colorectal cancer were investigated. Patient demographics,treatment characteristics,perioperative outcomes,and pathological results were evaluated retrospectively.Results There were 13 patients; 7 men and 6 women,with a median age of 60 years. 5 patients had rectal cancer,8 patients had sigmoid cancer,7 patients had a c T4 b tumor,and underwent complete resection of the primary tumor. The resected organ were the part of liver( n = 2),small intestine( n = 3),uterus( n =3),ovary( n = 4),bladder with ureter( n = 1) and right-side colon( n = 1). The median operative time was225 min( range 90-360 min),and the median blood loss was 50 ml( range 15-600 ml). None of the patients received intra-operative blood transfusions. There were 5 patients required conversion,3 patients were planned,2 were unplanned. All patients were R0 resection,and no peri-operative death occurred.Postoperative complications occurred in 2 patients. Conclusions Robotic-assisted multivisceral resection for colorectal cancer is safe and technically feasible.
引文
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7 吕赤,李瑾,张成,等.达芬奇机器人手术系统行直肠联合其他脏器切除4例报告[J].中国微创外科杂志,2014,14(11):1039-1041.
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11 许剑民.机器人结直肠癌手术专家共识(2015版)[J/CD].中华结直肠疾病电子杂志,2015,14(6):1305-1310.
12 Jacobs M,Verdeja JC,Goldstein HS. Minimally invasive colon resection(laparoscopic colectomy)[J]. Surg Laparosc Endosc,1991,1(3):144-150.
13 孙学军,郑见宝.腹腔镜结直肠癌手术治疗研究进展[J].西安交通大学学报(医学版),2016,37(5):613-621.
14 许平平,许剑民.机器人在结直肠癌手术中的应用现状[J].临床外科杂志,2017,25(4):255-258.
15 Lim DR,Min BS,Min SK,et al. Robotic versus laparoscopic anterior resection of sigmoid colon cancer:comparative study of longterm oncologic outcomes[J]. Surgical Endoscopy,2013,27(4):1379-1385.
16 姜勇,吴涛,万远廉,等. c T4bM0期原发直肠癌的外科治疗及预后分析[J].中华消化外科杂志,2013,12(6):417-421.
17 Pas MHVD,Haglind E,Cuesta MA,et al. Laparoscopic versus open surgery for rectal cancer(COLOR II):short-term outcomes of a randomised,phase 3 trial[J]. Lancet Oncology,2013,14(3):210-218.
18 De'Angelis N,Landi F,Vitali GC,et al. Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4rectal cancer[J]. Surgical Endoscopy,2017,31(8):1-16.
19 Kang SB,Park JW,Jeong SY,et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy(COREAN trial):short-term outcomes of an open-label randomised controlled trial[J]. Lancet Oncology,2010,11(7):637-645.
20 Bretagnol F,Dedieu A,Zappa M,et al. T4 colorectal cancer:is laparoscopic resection contraindicated[J]. Colorectal Disease,2011,13(2):138-143.
21 Manas MJ,Espin E,Lopez-Cano M,et al. Multivisceral resection for locally advanced rectal cancer:prognostic factors influencing outcome[J]. Scandinavian Journal of Surgery Sjs Official Organ for the Finnish Surgical Society&the Scandinavian Surgical Society,2014,104(3):154-160.
22 Kim KY, Hwang DW, Park YK, et al. A single surgeon's experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer:can the laparoscopic approach be performed safely[J]. Surgical Endoscopy&Other Interventional Techniques,2012,26(2):493-500.
23 Nagasue Y,Akiyoshi T,Ueno M,et al. Laparoscopic versus open multivisceral resection for primary colorectal cancer:comparison of perioperative outcomes[J]. Journal of Gastrointestinal Surgery Official Journal of the Society for Surgery of the Alimentary Tract,2013,17(7):1299-1305.
2 Hashizume M,Shimada M,Tomikawa M,et al. Early experiences of endoscopic procedures in general surgery assisted by a computerenhanced surgical system[J]. Surgical Endoscopy&Other Interventional Techniques,2002,16(8):1187-1191.
3 Duan BS,Zhao GH,Yang H,et al. A pooled analysis of robotic versus laparoscopic surgery for colon cancer[J]. Surgical Laparoscopy Endoscopy&Percutaneous Techniques,2016,26(6):523-530.
4 Yongzhi Yang MS,Feng W,Peng Z,et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease,focusing on rectal cancer:a meta-analysis[J]. Annals of Surgical Oncology,2012,19(12):3727-3736.
5 Yamaguchi T,Kinugasa Y,Shiomi A,et al. Robotic-assisted vs.conventional laparoscopic surgery for rectal cancer:short-term outcomes at a single center[J]. Surgery Today,2016,46(8):957-962.
6 贾宝庆.达芬奇机器人在胃肠手术中的应用[J/CD].中华腔镜外科杂志(电子版),2017,10(5):281-282.
7 吕赤,李瑾,张成,等.达芬奇机器人手术系统行直肠联合其他脏器切除4例报告[J].中国微创外科杂志,2014,14(11):1039-1041.
8 Shin US,Nancy YY,Nguyen AT,et al. Oncologic outcomes ofextended robotic resection for rectal cancer[J]. Annals of Surgical Oncology,2016,23(7):2249-2257.
9 Shin JW,Kim J,Kwak JM,et al. First report:robotic pelvic exenteration for locally advanced rectal cancer[J]. Colorectal Disease the Official Journal of the Association of Coloproctology of Great Britain&Ireland,2013,16(1):9-14.
10 Hino H, Yamaguchi T, Kinugasa Y, et al. Robotic-assisted multivisceral resection for rectal cancer:short-term outcomes at a single center[J]. Techniques in Coloproctology,2017,21(11):879-886.
11 许剑民.机器人结直肠癌手术专家共识(2015版)[J/CD].中华结直肠疾病电子杂志,2015,14(6):1305-1310.
12 Jacobs M,Verdeja JC,Goldstein HS. Minimally invasive colon resection(laparoscopic colectomy)[J]. Surg Laparosc Endosc,1991,1(3):144-150.
13 孙学军,郑见宝.腹腔镜结直肠癌手术治疗研究进展[J].西安交通大学学报(医学版),2016,37(5):613-621.
14 许平平,许剑民.机器人在结直肠癌手术中的应用现状[J].临床外科杂志,2017,25(4):255-258.
15 Lim DR,Min BS,Min SK,et al. Robotic versus laparoscopic anterior resection of sigmoid colon cancer:comparative study of longterm oncologic outcomes[J]. Surgical Endoscopy,2013,27(4):1379-1385.
16 姜勇,吴涛,万远廉,等. c T4bM0期原发直肠癌的外科治疗及预后分析[J].中华消化外科杂志,2013,12(6):417-421.
17 Pas MHVD,Haglind E,Cuesta MA,et al. Laparoscopic versus open surgery for rectal cancer(COLOR II):short-term outcomes of a randomised,phase 3 trial[J]. Lancet Oncology,2013,14(3):210-218.
18 De'Angelis N,Landi F,Vitali GC,et al. Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4rectal cancer[J]. Surgical Endoscopy,2017,31(8):1-16.
19 Kang SB,Park JW,Jeong SY,et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy(COREAN trial):short-term outcomes of an open-label randomised controlled trial[J]. Lancet Oncology,2010,11(7):637-645.
20 Bretagnol F,Dedieu A,Zappa M,et al. T4 colorectal cancer:is laparoscopic resection contraindicated[J]. Colorectal Disease,2011,13(2):138-143.
21 Manas MJ,Espin E,Lopez-Cano M,et al. Multivisceral resection for locally advanced rectal cancer:prognostic factors influencing outcome[J]. Scandinavian Journal of Surgery Sjs Official Organ for the Finnish Surgical Society&the Scandinavian Surgical Society,2014,104(3):154-160.
22 Kim KY, Hwang DW, Park YK, et al. A single surgeon's experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer:can the laparoscopic approach be performed safely[J]. Surgical Endoscopy&Other Interventional Techniques,2012,26(2):493-500.
23 Nagasue Y,Akiyoshi T,Ueno M,et al. Laparoscopic versus open multivisceral resection for primary colorectal cancer:comparison of perioperative outcomes[J]. Journal of Gastrointestinal Surgery Official Journal of the Society for Surgery of the Alimentary Tract,2013,17(7):1299-1305.