Controlled Study Of Clinical Effects Between Robotic And Laparoscopic For Radical Left Hemicolectomy

ObjectiveThe short-term,long-term and pathological efficacy of robot assisted left hemicolectomy were evaluated by comparing the clinical data of robot assisted and laparoscopic assisted left hemicolectomy.MethodsThe case samples who underwent left hemicolectomy completed by the same doctor team in gastrointestinal surgery of our hospital from July 2017 to July 2019 were retrospectively compared by using a single center database.The general information of patients were systematically evaluated.According to the inclusion and exclusion criteria,the included cases were screened out.A variety of statistical methods were used to evaluate the short-term,long-term and pathological efficacy of different surgical methods,such as robot and laparoscopy,in the radical operation of left colon cancer.The collected data include intraoperative data(bleeding volume,operation time,conversion rate of laparotomy,etc.),postoperative gastrointestinal function recovery data(first gas evacuation time,liquid diet time,first out of bed activity time,etc.),pathological data(total number of lymph nodes detected,maximum tumor diameter,postoperative pathological stage,etc.),postoperative survival rate and recurrence and metastasis.ResultsA total of 152 patients were included in the study,including 81 males and 71 females with the average age of 59.9±13.4 years old.Among them,84 cases(55.3%)underwent robotic-assisted left hemicolectomy(RA group).68 cases(44.7%)underwent laparoscopic-assisted left hemicolectomy(LA group).There was no significant difference in general data between the two groups.In terms of short-term efficacy,the patients in RA group had shorter time of first gas evacuation [(47.67 ± 15.08)h vs.(52.96 ± 11.87)h,P = 0.017],faster time of liquid diet [(72.55 ± 4.58)h vs.(75.74 ± 11.48)h,P = 0.034],earlier time of first out of bed activities [(25.94 ± 1.14)min vs.(28.25 ± 2.03)min,P < 0.05],shorter incision length [(5.93 ± 1.19)cm vs.(6.82 ± 2.19)cm,P = 0.002],but the operation cost of RA group was also higher [(60483.30 ± 3548.06)yuan vs.(46940.68 ± 8682.31)yuan,P < 0.05].In terms of long-term efficacy,the average follow-up period was 24 months.5 cases were lost in RA group and 4 cases in La group.In this study,9 patients in RA group had postoperative recurrence and 6 died;13 patients in La group had postoperative recurrence and 9 died.The 2-year tumor-free survival rate in the two groups was 77.5% and 71.8%,respectively.The overall 2-year survival rate was 84.2% and 81.9%,respectively.There was no significant difference between the two groups.In terms of pathological efficacy,there was no significant difference in the total number of lymph nodes detected [(14.69±7.00)vs(14.25 ± 6.32),P = 0.688),the number of positive lymph nodes [(1.21±2.60)vs(1.66 ± 2.84),P = 0.313),maximum tumor diameter [(4.24 ± 1.46)cm vs(4.95 ± 3.73)cm,P = 0.143)between the two groups(P > 0.05).Conclusion1.Robotic-assisted left hemicolectomy has the characteristics of fast recovery and small auxiliary incision,but the cost of operation is significantly higher than that of laparoscopic operation.2.Robotic-assisted left hemicolectomy has similar oncology effect and long-term efficacy as laparoscopic operation.