| Objective:Robot assisted surgery is a new stage in the development of minimally invasive surgery and represents a leap in surgical philosophy and surgical equipoise.Compared with traditional minimally invasive surgery,robotic surgery has some advantages such as shorter learning curve,more flexible and precise operation,and more labor saving,but the disadvantages are more expensive and higher technical access criteria.In the field of colorectal surgery,traditional general laparoscopic surgery is still mainstream,and there is still a lack of strong evidence to support the use of robots in colorectal surgery.The purpose of this study included: 1.To compare the short-term clinical outcomes of D3 radical surgery for colorectal cancer using robotic versus general laparoscopic assistance.2.To explore the potential advantages of robot assisted surgery in colorectal surgery.Methods:Single primary colorectal cancer patients who underwent robotic laparoscopic radical surgery at the Department of Gastroenterological Surgery,Sichuan Provincial People’s Hospital,from September 2014 to December 2021 were included,and cases of general laparoscopic surgery were matched in a 1:1ratio using SPSS 26.0 software,with matching variables including patient age,surgical procedure,and whether neoadjuvant therapy was performed.All patients were from the same medical group,and surgery was performed according to membrane dissection D3 radical.The intraoperative conditions,postoperative recovery,postoperative complications,and length and cost of postoperative hospital stay were compared between the two groups.Factors affecting the occurrence of complications and factors associated with prolonged postoperative hospital stay were evaluated by multivariate regression analysis with logistic regression.Results:A total of 305 patients were included in the study,152 in the robotic group and 153 in the general laparoscopic group.1.There were no significant differences between robotic and general laparoscopic groups in age,gender,BMI,ASA,presence or absence of diabetes mellitus,presence or absence of hypertension,previous abdominal surgery,presence or absence of neoadjuvant therapy,type of surgery,tumor markers,tumor size,number of lymph nodes,circumferential resection margin and TNM stage in general and pathological findings(P > 0.05).2.Intraoperative blood loss was less in the robotic group than in the general laparoscopic group(P< 0.001),and operative time was longer than in the general laparoscopic group(P=0.04);There was no significant difference between the groups in terms of whether or not stoma was created,whether or not conversion to laparotomy,intraoperative fluid infusion,and intraoperative urine output(P > 0.05).3.Postoperative flatus duration time(P<0.001),postoperative drain removal time(P=0.043),postoperative flow diversion time(P<0.001)in the robotic group all earlier than the general laparoscopic group;Their comparative differences were all statistically significant;There were no significant differences in postoperative NLR,postoperative PLR,postoperative PCT and postoperative CRP(P > 0.05).4.The number of overall complications was significantly lower in the robotic group(P=0.029),the number of intraoperative blood transfusions in the robotic group(P=0.047),the number of postoperative anastomotic leaks(P=0.038),the number of postoperative urinary retentions(P =0.036)were both significantly lower than those of the plain laparoscopic group.According to Clavien-Dindo complication grading,the number of grade II and III complications in the robotic group was significantly lower than that in the general laparoscopic group(P=0.021);There were no significant differences between robotic and general laparoscopic groups regarding postoperative anemia,postoperative incision infection,postoperative ileus,postoperative pulmonary infection,and death within 30 days of operation(P>0.05).5.Postoperative hospital stay was shorter in the robotic group than in the plain laparoscopic group(P=0.044),and total costs were higher than in the plain laparoscopic group(P< 0.001);There was no significant difference in the total length of hospital stay or 30 day readmission rate between the two groups(P>0.05).6.Univariate and multivariate logistic regression analysis for any complication revealed that surgical approach(OR1.84;P=0.022),intraoperative blood transfusion(OR3.44;P=0.014),postoperative NLR(OR1.04;P=0.005),postoperative PLR(OR1.0;P=0.014),postoperative ALB(OR0.85;P<0.001),postoperative CRP(OR1.02;P<0.001),and postoperative PCT(OR1.43;P<0.001)were predictive of any complication.Multivariate analysis revealed that postoperative ALB(OR0.87;P<0.001),postoperative PCT(OR1.33;P=0.002)and postoperative CRP(OR1.02;P=0.003)were predictive of any complication,with postoperative ALB being the protective factor against any complication (OR0.87;P<0.001).7.Univariate and multivariate logistic regressions were used to identify postoperative length of stay > 7 days,and univariate analysis showed that age(OR1.02;P=0.02),surgical approach(OR2.41;P<0.001),ASA(OR2.68;P=0.005),arbitrary complications(OR5.14;P<0.001),and postoperative ALB(OR0.89;P=0.02)were risk factors for postoperative length of stay > 7 days.Multivariate analysis revealed that ASA class III(OR2.51;P=0.017),arbitrary complications(OR4.76;P<0.001),and general laparoscopic surgery(OR2.14;P=0.003)were the risk factors associated with a postoperative hospital stay of >7 days,with robotic surgery being the protective factor associated with a prolonged postoperative hospital stay.Conclusion: 1.The pathological outcomes of robotic surgery versus general laparoscopic surgery are comparable.2.Robot application in the radical resection of colorectal cancer is a safe,effective,and feasible procedure.3.Robotic surgery offers the advantages of better minimally invasive access,less intraoperative bleeding,less postoperative inflammatory response,faster postoperative recovery,less severe complications,and shorter postoperative hospital stay but at higher total costs. |
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