| OBJECTIVE:To study and analyze the recent clinical efficacy of da Vinci robotic radical colorectal cancer surgery.METHODS:The clinical data of 260 patients who underwent robotic or laparoscopic radical colorectal cancer treatment for colorectal cancer admitted to our department between April 2021 and August 2022 were retrospectively analyzed.In the robotic group: 80cases(57.1%)in men and 60 cases(42.9%)in women,age 26-83 years,median age 63 years,body mass index(BMI)24.2±3.6 kg/m2.60 cases of radical surgery for colon cancer,16 cases of radical surgery for right hemicolectomy,3 cases of radical surgery for left hemicolectomy,and 41 cases of radical surgery for sigmoid colon cancer.There were 80 cases of radical rectal cancer,70 cases of Dixon and 10 cases of Miles.Laparoscopic group: 84 cases(70.0%)in men and 36 cases(30.0%)in women,age 33-83 years,median age 65 years,body mass index(BMI)23.3±2.9 kg/m2.51 cases of radical surgery for colon cancer,28 cases of radical surgery for right hemicolectomy,8cases of radical surgery for left hemicolectomy and 15 cases of radical surgery for sigmoid colon cancer.There were 69 cases of radical rectal cancer,47 cases of Dixon and 22 cases of Miles.The general data,oncological data,operation time,intraoperative bleeding,number of lymph node dissection,dose of postoperative pain medication,postoperative related complications(anastomotic leak,postoperative intestinal obstruction,difficulty in urination,incisional infection),time of removal of urinary catheter,time of postoperative venting,time of starting to eat clear liquid food after operation,total hospitalization cost,postoperative hospitalization time and other recent efficacy of the two groups were compared.RESULTS:(1)In terms of general clinical data,in the robotic group: 80 cases(57.1%)in men and 60 cases(42.9%)in women,age 26-83 years,median age 63 years,body mass index(BMI)24.2±3.6 kg/m2.60 cases of radical colon cancer,16 cases of radical right hemicolectomy,3 cases of radical left hemicolectomy and 41 cases of radical sigmoid colon cancer The radical surgery for rectal cancer was performed in 80 cases.There were 80 cases of radical rectal cancer,70 cases of Dixon and 10 cases of Miles.Laparoscopic group: 84 cases(70.0%)in men,36 cases(30.0%)in women,age 33-83 years,median age 65 years,body mass index(BMI)23.3±2.9 kg/m2.51 cases of radical surgery for colon cancer,28 cases of radical surgery for right hemicolectomy,8 cases of radical surgery for left hemicolectomy,15 cases of radical surgery for sigmoid colon cancer.There were 69 cases of radical rectal cancer,47 cases of Dixon and 22 cases of Miles.Comparing the cases in the two groups,there were no statistically significant differences in age,gender,BMI,presence of hypertension diabetes coronary heart disease,and whether preoperative symptoms were accompanied by obstruction(P >0.05).(2)In terms of oncology,all pathological specimens were negative for both cutend margins and peri-annular margins.There were no statistically significant differences in tumor diameter,tumor stage,tumor differentiation,whether mucinous adenocarcinoma was combined,whether the tumor budded,and whether there was pulsed and nerve involvement between the robotic and laparoscopic groups(P > 0.05).(3)In the radical rectal cancer Dixon,the operative time: 198.93 ± 40.52 min in the robotic group and 151.21 ± 33.43 min in the laparoscopic group,the robot group took longer time,P < 0.01,and the difference was statistically significant.Intraoperative bleeding: 54.76±31.49 ml in the robotic group and 72.45±28.68 ml in the laparoscopic group,with less intraoperative bleeding in the robotic group,P=0.003<0.01,and the difference was statistically significant.The number of lymph node dissection:19.16±5.32 in the robotic group and 16.32±3.63 in the laparoscopic group,the number of lymph node dissection was more in the robotic group,P=0.002<0.01,and the difference was statistically significant.Time to first postoperative defecation: 2.5(1-3)d in the robotic group and 3(2-3)d in the laparoscopic group,the robotic group was earlier,P=0.046 < 0.05,the difference was statistically significant.Time to first postoperative bowel movement: 3(2-3)d in the robotic group and 3(2-4)d in the laparoscopic group,earlier in the robotic group,P=0.040<0.05,a statistically significant difference.Postoperative time to clear liquid food: 3(2-4)d in the robotic group and 4(3-4)d in the laparoscopic group,earlier in the robotic group,P=0.016<0.05,the difference was statistically significant.Postoperative analgesic dosage:285.14±132.95 mg in the robotic group and 363.19±111.67 mg in the laparoscopic group,less in the robotic group,P=0.001<0.05,a statistically significant difference.Hospitalization cost: 98232(92,433-107329)yuan in the robotic group and 66,703(59,294-72713)yuan in the laparoscopic group,which was more expensive in the robotic group,P < 0.01,and the difference was statistically significant.The two groups in whether prophylactic fistula(P=0.240),postoperative time to leave bed(P=0.141),postoperative time to remove urinary catheter(P=0.427),postoperative hospital days(P=0.363),anastomotic leak(P=0.182),postoperative bowel obstruction(P=0.343),difficulty in urination(P=0.881),and incisional infection(P=0.873)The differences were not statistically significant(P > 0.05).(4)In the radical rectal cancer Miles,in terms of operative time,230.00±38.51 min in the robotic group and 183.55±40.65 min in the laparoscopic group,the robotic group took longer time,P=0.005<0.01,the difference was statistically significant.The number of lymph nodes cleared: 21.00±4.27 in the robotic group and 17.18±3.69 in the laparoscopic group,the number of lymph nodes cleared was more in the robotic group,P=0.015<0.05,and the difference was statistically significant.Postoperative feeding time of clear fluid: 2.90±0.99 d in the robotic group and 3.95±1.29 d in the laparoscopic group,earlier in the robotic group,P=0.029<0.05,the difference was statistically significant.Postoperative urinary catheter removal time: 3.0(2.0-3.8)d in the robotic group and 4.0(3.0-5.0)d in the laparoscopic group,earlier in the robotic group,P=0.038<0.05,the difference was statistically significant.Hospitalization cost: 100738(94122-112320)yuan in the robotic group and 65860(59895-73917)yuan in the laparoscopic group,which was higher in the robotic group,P < 0.01,a statistically significant difference.The two groups had higher intraoperative bleeding(P=0.952),time to first postoperative venting(P=0.928),time to first defecation(P=0.745),time to leave bed for activity(P=0.224),postoperative analgesic dosage(P=0.367),postoperative hospital days(P=0.590),postoperative bowel obstruction(P=1.000),difficulty in urination(P=0.572),and There was no statistically significant difference(P > 0.05)in incisional infection(P=0.534).Among 45 patients with low rectal cancer,Dixon was performed in 18 out of 28 cases(64.3%)in the robotic group and 1 out of17 cases(5.9%)in the laparoscopic group,and the anus preservation rate was higher in the robotic group compared with the robotic group,P < 0.01,which was statistically significant.(5)In radical colon cancer surgery,the operation time: 203.88±41.70 min in the robotic group and 185.39±32.50 min in the laparoscopic group,the operation time was longer in the robotic group,P=0.011<0.05,and the difference was statistically significant.The number of lymph nodes cleared: 21(17-24)in the robotic group and19(15-22)in the laparoscopic group,with more lymph nodes cleared in the robotic group,P=0.003<0.05,and the difference was statistically significant.Postoperative time to leave bed: 2(2-3)d in the robotic group and 3(2-3)d in the laparoscopic group,the robotic group left bed earlier,P=0.014<0.05,the difference was statistically significant.Hospitalization cost: 98,176 ± 13,155 yuan in the robotic group and 65,256± 10,211 yuan in the laparoscopic group,with higher hospitalization cost in the robotic group,P < 0.01,a statistically significant difference.The two groups had higher intraoperative bleeding(P=0.162),time to first postoperative venting(P=0.086),time to first postoperative bowel movement(P=0.905),time to clear liquid food(P=0.111),time to urinary catheter removal(P=0.249),postoperative analgesic dosage(P=0.265),postoperative hospitalization days(P=0.644),anastomotic leak(P=0.908),postoperative intestinal obstruction(P=0.465),and incisional infection(P=0.619)were not statistically significant differences(P>0.05).(I)In radical surgery for sigmoid colon cancer,the operation time: 199.37±43.89 min in the robotic group and 165.67±32.34 min in the laparoscopic group,the two groups took longer to complete this operation compared to the robotic group,P=0.009<0.05,the difference was statistically significant.The number of lymph nodes cleared: 20(17-23.5)in the robotic group and16(12-20)in the laparoscopic group,the number of lymph nodes cleared was more in the robotic group,P=0.005<0.05,the difference was statistically significant.Hospitalization cost: 99,171±11,943 yuan in the robotic group and 65,590±2486 yuan in the laparoscopic group,with higher cost in the robotic group,P<0.05,a statistically significant difference.In both groups,the differences in intraoperative bleeding(P=0.845),time to first postoperative evacuation(P=0.674),time to first postoperative bowel movement(P=0.119),time to clear liquid food(P=0.322),time to leave bed for activity(P=0.147),time to remove urinary catheter(P=0.706),amount of postoperative analgesic(P=0.239),and number of postoperative hospital days(P=0.713),anastomotic leak(P=0.450),postoperative bowel obstruction(P=0.450),and incisional infection(P=0.933)were not statistically significant(P>0.05).ii)In radical left hemicolectomy for left colon cancer,operative time: 223.33±32.15 min in the robotic group and172.75±19.91 min in the laparoscopic group.The operative time was longer in the robotic group,P=0.010<0.05,and the difference was statistically significant.Hospitalization cost: RMB 93,023±13,051 in the robotic group and RMB62,689±10,106 in the laparoscopic group,the cost was higher in the robotic group,P=0.003<0.05,and the difference was statistically significant.The two groups had higher intraoperative bleeding(P=0.866),number of lymph nodes cleared(P=0.212),time to first postoperative evacuation(P=0.885),time to first postoperative bowel movement(P=0.944),time to clear liquid food after surgery(P=0.885),time to leave bed after surgery(P=0.637),time to remove urinary catheter after surgery(P=0.261),and amount of postoperative analgesic(P=0.591),postoperative hospitalization days(P=0.218),and incisional infection(P=0.491)were not statistically significant(P>0.05).iii)In radical surgery for right hemicolectomy,the number of lymph nodes cleared:22.56±5.03 in the robotic group and 19.68±2.93 in the laparoscopic group,the number of lymph nodes cleared was more in the robotic group,P= 0.020<0.05,the difference was statistically significant.Time to leave bed after surgery: 2(2-3)d in the robotic group and 3(3-3)d in the laparoscopic group,the robotic group left bed earlier after surgery,P=0.038<0.05,the difference was statistically significant.Hospitalization cost:$96,594±16,338 in the robotic group and $65,811±10,780 in the laparoscopic group,with higher cost in the robotic group,P<0.01,a statistically significant difference.The two groups had higher costs in terms of operative time(P=0.230),intraoperative bleeding(P=0.637),time to first postoperative evacuation(P=0.176),time to first postoperative bowel movement(P=0.523),time to clear liquid food(P=0.077),time to postoperative urinary catheter removal(P=0.135),postoperative analgesic dosage(P=0.800),postoperative hospitalization days(P= 0.294),postoperative intestinal obstruction(P=1.000),and incisional infection(P=0.682)were not statistically significant(P>0.05).CONCLUSIONS:1.Da Vinci robotic radical colorectal cancer surgery is safe,feasible and effective,with oncologic outcomes similar to those of laparoscopic radical colorectal cancer surgery.2.da Vinci robotic surgery system has a better anal preservation rate than laparoscopy in patients with low rectal cancer.3.da Vinci robotic radical rectal cancer surgery has a longer operative time,less intraoperative bleeding,and more lymph node dissection than laparoscopic radical rectal cancer surgery.The number of lymph nodes dissected,postoperative gastrointestinal function recovery is faster,pain is less,and urinary catheter removal is earlier,achieving the goal of more minimally invasive surgery.4.da Vinci robotic radical surgery for colorectal cancer requires higher surgical costs. |
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