Intersphincteric resection following robotic-assisted versus laparoscopy-assisted total mesorectal excision for middle and low rectal cancer: a multicentre propensity score analysis of 1571 patients

作者全名：Guo, Yuchen; He, Liang; Tong, Weidong; Ren, Shuangyi; Chi, Zhaocheng; Tan, Ke; Wang, Bo; Lie, Chunxiao; Wang, Quan

作者地址：[Guo, Yuchen; He, Liang; Wang, Quan] First Hosp Jilin Univ, Gen Surg Ctr, Dept Gastrocolorectal Surg, Changchun 130012, Peoples R China; [Tong, Weidong; Tan, Ke] Jilin Prov Tumour Hosp, Changchun, Peoples R China; [Ren, Shuangyi; Wang, Bo] Third Mil Med Univ, Daping Hosp, Chongqing, Peoples R China; [Ren, Shuangyi; Wang, Bo] Third Mil Med Univ, Chongqing Municipal, Res Inst Surg, Chongqing, Peoples R China; [Chi, Zhaocheng; Lie, Chunxiao] Dalian Med Univ, Affiliated Hosp 2, Dept Orthoped, Dalian, Peoples R China; [Wang, Quan] First Hosp Jilin Univ, Gen Surg Ctr, Dept Gastrocolorectal Surg, 1 Xinmin St, Changchun, Jilin, Peoples R China

通信作者：Wang, Q (通讯作者)，First Hosp Jilin Univ, Gen Surg Ctr, Dept Gastrocolorectal Surg, 1 Xinmin St, Changchun, Jilin, Peoples R China.

来源：INTERNATIONAL JOURNAL OF SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001203304700072

JCR分区：Q1

影响因子：12.5

年份：2024

卷号：110

期号：4

开始页：1904

结束页：1912

文献类型：Article

关键词：intersphincteric resection; laparoscopy; rectal cancer; robot; total mesorectal excision

摘要：Background:Robotic-assisted total mesorectal excision (RaTME) may be associated with reduced conversion to an open approach and a higher rate of complete total mesorectal excision (TME); however, studies on its advantages in intersphincteric resection (ISR) are inadequate.Materials and methods:This retrospective multicenter cohort study enroled consecutive patients who underwent RaTME and laparoscopy-assisted total mesorectal excision (LaTME) at four medical centres between January 2020 and March 2023. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and multivariate logistic regression analyses were performed. The primary outcome was the ISR rate. Secondary outcomes were coloanal anastomosis (CAA), conversion to open surgery, conversion to transanal TME, abdominoperineal resection, postoperative morbidity and mortality within 30 days, and pathological outcomes.Results:Among the 1571 patients, 1211 and 450 underwent LaTME and RaTME, respectively, with corresponding ISR incidences of 5.3% and 8.4% (P=0.024). After PSM and IPTW, RaTME remained associated with higher ISR rates (4.5% versus 9.4%, P=0.022 after PSM; 4.9% versus 9.2, P=0.005 after IPTW). This association remained in multivariate analysis after adjusting for other confounding factors. RaTME was further associated with a higher CAA rate, longer operating time, and higher hospitalization expenses.Conclusions:RaTME may facilitate ISR in middle and low rectal cancers, showing an independent association with a higher ISR incidence, with pathological outcomes and complications comparable to those of LaTME. However, it may also require a longer operating time and incur higher hospitalization expenses.

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