机器人与腹腔镜直肠癌手术对手术预后的影响——一项回顾性队列研究

Impact of Robotic versus Laparoscopic Surgery for Rectal Cancer on Surgical Prognosis—A Retrospective Cohort Study

摘要: 本研究通过一项回顾性单中心队列研究比较机器人辅助直肠切除术与传统腹腔镜和开放方法的结果，重点关注并发症发生率、转化率、住院时间和肿瘤结局。包括106例因非转移性直肠癌行手术治疗的患者。患者被分配到开放手术(n = 23)、常规腹腔镜手术(n = 55)或机器人辅助手术(n = 28)。与开放手术(17.91 ± 12天)和腹腔镜手术(17.2 ± 14天)相比，机器人手术的转化率显著降低，住院时间更短(11.5 ± 8天，p = 0.001)。与腹腔镜手术(47.83%)相比，机器人(85.71%)和开放(89.09%)病例的标本质量显着更好(p < 0.001)。腹腔镜手术被确定为标本质量较差的危险因素(p < 0.001)。老年患者(>63岁)在单变量分析中具有更高的转换风险(p = 0.049)。两组间并发症发生率相当(p = 0.131)，吻合口瘘率无显著差异(腹腔镜：18.18%，开放：13.04%，机器人：17.86%)。K-M曲线显示各组总生存率无显著差异。机器人辅助直肠切除术在转化率更低、标本质量更好、住院时间更短方面具有显着优势，同时保持与传统腹腔镜和开放入路相当的并发症发生率和肿瘤学结局。这些发现支持机器人手术作为直肠癌的标准治疗选择。

Abstract: This study compared the results of robot-assisted rectal resection with conventional laparoscopic and open methods in a retrospective single-center cohort study, focusing on complication rates, conversion rates, length of hospital stay, and oncological outcomes. A total of 106 patients who underwent surgery for non-metastatic rectal cancer were included. Patients were assigned to open surgery (n = 23), conventional laparoscopic surgery (n = 55), or robot-assisted surgery (n = 28). Compared with open surgery (17.91 ± 12 days) and laparoscopic surgery (17.2 ± 14 days), robotic surgery had a significantly lower conversion rate and shorter hospital stay (11.5 ± 8 days, p = 0.001). Compared with laparoscopic surgery (47.83%), robotic (85.71%) and open (89.09%) cases had significantly better specimen quality (p < 0.001). Laparoscopic surgery was identified as a risk factor for poor specimen quality (p < 0.001). Elderly patients (>63 years) had a higher risk of conversion in univariate analysis (p = 0.049). There was no significant difference in the incidence of complications between the two groups (p = 0.131). There was no significant difference in the incidence of anastomotic leakage between the two groups (laparoscopic: 18.18%, open: 13.04%, robotic: 17.86%). The K-M curve showed no significant difference in overall survival between the groups. Robot-assisted rectal resection has significant advantages in terms of lower conversion rate, better specimen quality, and shorter hospital stay, while maintaining comparable complication rates and oncologic outcomes to conventional laparoscopic and open approaches. These findings support robotic surgery as a standard treatment option for rectal cancer.