机器人辅助远端乙状结肠癌和直肠癌根治术的近期临床疗效
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摘要
目的探讨机器人辅助远端乙状结肠癌和直肠癌根治术的近期临床疗效。方法回顾性分析2016年8月—2018年12月天津医科大学肿瘤医院12例接受机器人辅助远端乙状结肠癌(4例)和直肠癌根治术患者(8例)的临床资料,其中男5例,女7例,年龄27～72岁,中位年龄59.5岁。观察手术和术后恢复情况、术后病理学检查情况。采用门诊及电话方式进行随访,了解患者术后生存、肿瘤复发和转移情况。结果 12例患者均顺利完成机器人辅助远端乙状结肠癌和直肠癌根治术,无中转传统腹腔镜或开腹手术。12例患者的手术时间为(282.50±90.72)min,术中出血量为(91.67±41.74)mL,未发生术中并发症。12例患者中3例发生术后并发症,肠梗阻、吻合口漏和脑梗死各1例。脑梗死患者转回当地继续治疗,肠梗阻和吻合口漏患者经保守治疗后好转。术后住院时间为(11.25±4.22)d。术后12例患者淋巴结清扫数目为(18.50±7.75)枚。手术切缘均为阴性,8例直肠癌患者远切缘距离为(2.21±0.88)cm。病理学T分期:ypT0期1例,pT1期2例,pT2期2例,pT3期5例,pT4a期2例。病理学N分期:pN0期7例,pN1期3例,pN2期2例。病理学类型:中分化腺癌10例,低分化腺癌2例。12例均获得术后随访,随访时间为1～28个月,中位随访时间18个月。随访期间,1例因脑梗死死亡,其余患者均无肿瘤复发、转移和死亡。结论机器人辅助远端乙状结肠癌和直肠癌根治术安全可行,近期疗效满意。
Objective To investigate the clinical efficacy of robot-assisted radical resection for distal sigmoid colon and rectal cancer.MethodsThe clinical data of 12 patients underwent robot-assisted radical resection for distal sigmoid colon(n=4) and rectal cancer(n=8) at the Tianjin Medical University Cancer Hospital from August 2016 to December 2018 were retrospectively analyzed. The patients included 5 males and 7 females, ranging in age from 27-72 years with a median age of 59.5 years. Surgical, postoperative recovery and postoperative pathological examination were observed. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative survival, recurrence and tumor metastasis of patients.ResultsAll the 12 patients successfully completed operation with robot-assisted radical resection of distal sigmoid and rectal cancer, without conversion to conventional laparoscopic or open surgery. The operation time and intraoperative blood loss were(282.50±90.72) min and(91.67±41.74) mL respectively without intraoperative complications.Among these patients, there were three with postoperative complications, one case with intestinal obstruction, one case with anastomotic leakage and one with acute ischemic stroke. The patient with acute ischemic stroke was transferred to local hospital for further treatment, and the other two patients with intestinal obstruction and the anastomotic leakage improved after conservative treatment. The duration of postoperative hospital stay was(11.25±4.22) d. The number of harvested lymph nodes after operation was(18.50±7.75) in 12 patients. Surgical margins were negative in 12 patients, and the distance of distal surgical resection margin was(2.21±0.88) cm in 8 patients with rectal cancer. Postoperative tumor pathological staging showed that stage ypT0 was detected in 1 case, pT1 in 2 cases, pT2 in 2 cases, pT3 in 5 cases and pT4 a in 2 patients.Postoperative pathological N staging showed that stage pN0 was detected in 7 patients, pN1 in 3 patients and pN2 in 2 patients, respectively. Postoperative tumor pathological type showed that 10 patients were diagnosed with moderate differentiated adenocarcinoma and 2 patients were diagnosed with low differentiated adenocarcinoma respectively. All the 12 patients were followed-up for 1 to 28 months, with a median follow-up period of 18 months. During the follow-up period, 1 patient died of ischemic stroke and the others had disease-free survival, no recurrence, metastasis or death.Conclusion Robot-assisted radical resection for distal sigmoid colon and rectal cancer is safe and feasible with satisfactory short-term results.
Objective To investigate the clinical efficacy of robot-assisted radical resection for distal sigmoid colon and rectal cancer.MethodsThe clinical data of 12 patients underwent robot-assisted radical resection for distal sigmoid colon(n=4) and rectal cancer(n=8) at the Tianjin Medical University Cancer Hospital from August 2016 to December 2018 were retrospectively analyzed. The patients included 5 males and 7 females, ranging in age from 27-72 years with a median age of 59.5 years. Surgical, postoperative recovery and postoperative pathological examination were observed. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative survival, recurrence and tumor metastasis of patients.ResultsAll the 12 patients successfully completed operation with robot-assisted radical resection of distal sigmoid and rectal cancer, without conversion to conventional laparoscopic or open surgery. The operation time and intraoperative blood loss were(282.50±90.72) min and(91.67±41.74) mL respectively without intraoperative complications.Among these patients, there were three with postoperative complications, one case with intestinal obstruction, one case with anastomotic leakage and one with acute ischemic stroke. The patient with acute ischemic stroke was transferred to local hospital for further treatment, and the other two patients with intestinal obstruction and the anastomotic leakage improved after conservative treatment. The duration of postoperative hospital stay was(11.25±4.22) d. The number of harvested lymph nodes after operation was(18.50±7.75) in 12 patients. Surgical margins were negative in 12 patients, and the distance of distal surgical resection margin was(2.21±0.88) cm in 8 patients with rectal cancer. Postoperative tumor pathological staging showed that stage ypT0 was detected in 1 case, pT1 in 2 cases, pT2 in 2 cases, pT3 in 5 cases and pT4 a in 2 patients.Postoperative pathological N staging showed that stage pN0 was detected in 7 patients, pN1 in 3 patients and pN2 in 2 patients, respectively. Postoperative tumor pathological type showed that 10 patients were diagnosed with moderate differentiated adenocarcinoma and 2 patients were diagnosed with low differentiated adenocarcinoma respectively. All the 12 patients were followed-up for 1 to 28 months, with a median follow-up period of 18 months. During the follow-up period, 1 patient died of ischemic stroke and the others had disease-free survival, no recurrence, metastasis or death.Conclusion Robot-assisted radical resection for distal sigmoid colon and rectal cancer is safe and feasible with satisfactory short-term results.
引文
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[6]Broholm M,Pommergaard HC,G?genür I.Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction:a systematic review and meta-analysis[J].Colorectal Dis,2015,17(5):375-381.doi:10.1111/codi.12872.
[7]Luca F,Craigg DK,Senthil M,et al.Sexual and urinary outcomes in robotic rectal surgery:review of the literature and technical considerations[J].Updates Surg,2018,70(3):415-421.doi:10.1007/s13304-018-0581-x.
[8]Matsuyama T,Kinugasa Y,Nakajima Y,et al.Robotic-assisted surgery for rectal cancer:Current state and future perspective[J].Ann Gastroenterol Surg,2018,2(6):406-412.doi:10.1002/ags3.12202.
[9]Bokhari MB,Patel CB,Ramos-Valadez DI,et al.Learning curve for robotic-assisted laparoscopic colorectal surgery[J].Surg Endosc,2011,25(3):855-860.doi:10.1007/s00464-010-1281-x.
[10]Jayne D,Pigazzi A,Marshall H,et al.Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer:the ROLARR randomized clinical trial[J].JAMA,2017,318(16):1569-1580.doi:10.1001/jama.2017.7219.
[2]中华医学会外科学分会腹腔镜与内镜外科学组,中华医学会外科学分会结直肠外科学组,中国医师协会外科医师分会结直肠外科医师委员会,等.腹腔镜结直肠癌根治术操作指南(2018版)[J].中华消化外科杂志,2018,17(9):877-885.Laparoscopic&Endoscopic Surgery Group,Branch of Surgery,Chinese Medical Association;Colorectal Surgery Group,Branch of Surgery,Chinese Medical Association;Chinese Society of Colon and Rectal Surgeons,Chinese Medical Doctor Association;et al.Guideline for operative procedure of laparoscopic radical resection of colorectal cancer(2018 edition)[J].Chin J Dig Surg,2018,17(9):877-885.doi:10.3760/cma.j.issn.1673-9752.2018.09.001.
[3]中国医师协会外科医师分会结直肠外科医师委员会,中国研究型医院学会机器人与腹腔镜外科专业委员会.机器人结直肠癌手术专家共识(2015版)[J].中华消化外科杂志,2015,14(11):891-897.Professional Committee of Colorectal Surgeons,Chinese College of Surgeons of Chinese Medical Doctor Association,Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association.Expert consensus of robotic surgery in colorectal cancer(2015 edition)[J].Chin J Dig Surg,2015,14(11):891-897.doi:10.3760/cma.j.issn.1673-9752.2015.11.002.
[4]Park EJ,Baik SH.Robotic surgery for colon and rectal cancer[J].Curr Oncol Rep,2016,18(1):5.doi:10.1007/s11912-015-0491-8.
[5]汤思哲,王仆,孔大陆.达芬奇机器人手术系统结直肠癌根治术的现状和展望[J].中国肿瘤临床,2019,46(7):370-374.Tang SZ,Wang P,Kong DL.Updates and prospect of the da Vinci robotic surgical system in radical resection of colorectal cancer[J].Chin JClin Oncol,2019,46(7):370-374.doi:10.3969/j.issn.1000-8179.2019.07.153.
[6]Broholm M,Pommergaard HC,G?genür I.Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction:a systematic review and meta-analysis[J].Colorectal Dis,2015,17(5):375-381.doi:10.1111/codi.12872.
[7]Luca F,Craigg DK,Senthil M,et al.Sexual and urinary outcomes in robotic rectal surgery:review of the literature and technical considerations[J].Updates Surg,2018,70(3):415-421.doi:10.1007/s13304-018-0581-x.
[8]Matsuyama T,Kinugasa Y,Nakajima Y,et al.Robotic-assisted surgery for rectal cancer:Current state and future perspective[J].Ann Gastroenterol Surg,2018,2(6):406-412.doi:10.1002/ags3.12202.
[9]Bokhari MB,Patel CB,Ramos-Valadez DI,et al.Learning curve for robotic-assisted laparoscopic colorectal surgery[J].Surg Endosc,2011,25(3):855-860.doi:10.1007/s00464-010-1281-x.
[10]Jayne D,Pigazzi A,Marshall H,et al.Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer:the ROLARR randomized clinical trial[J].JAMA,2017,318(16):1569-1580.doi:10.1001/jama.2017.7219.