| Objective To compare the clinical efficacy of Da Vinci robotic surgery system and laparoscopic radical resection of colorectal cancer.Methods Retrospective analysis of 136 cases of laparoscopic-assisted colorectal cancer radical surgery from May 2016 to May 2017 and 113 cases of robot-assisted radical colorectal cancer radical surgery from August 2017 to August 2018.The postoperative pathology of all cases was stage I to III adenocarcinoma.Among them,the robot group:74 male patients,39female patients,aged 29-84 years,median age 63 years,body mass index(BMI)23.5±1.6 kg/m~2,There were 62 cases of rectal cancer anterior resection(Dixon),18 cases of transabdomina l perineal resection for rectal cancer(Miles),17 cases of sigmoid colon cancer radical operation,5 cases of left colon cancer radical operation,and 11 cases were treated with radical resection of right colon cancer.Laparoscopic group:88 male patients,48 females,aged 31-87 years,median age 60 years,body mass index(BMI)22.9±1.4 kg/m~2,60 cases of rectal cancer anterior resection(Dixon),33 cases of transabdominal perineal resection for rectal cancer(Miles),13cases of sigmoid colon cancer radical operation,10 cases of left colon cancer radical operation,and 20 cases were treated with radical resection of right colon cancer.Complications:Robotic group:9 cases of anastomotic leakage;10 cases of intestinal obstruction;14 cases of wound infection:3 cases of dysuria.Laparoscopic group:4 cases of anastomotic leakage;10 cases of intestinal obstruction;18 cases of wound infection:5 cases of dysuria.Things were compared between the two groups:the general data,duration of surgery,amount of bleeding,days of hospitalization after surgery,time of first exhaust after surgery,time of first defecation after surgery,number of lymph nodes removed,postoperative complications and postoperative disease-free survival time.Results Da Vinci robots and laparoscopic data were not statistically different in terms of age,gender,body mass index,etc.The data of the two groups were comparable.(1)In the low rectal Miles operation,postoperative urinary catheterization time:robot group 2-7d,mean3.11±1.66d;laparoscopic group 2-9d,average 4.32±1.06d.The time of remove the catheter between two groups was lower in the robot group after surgery,P=0.02.Number of lymph nodes cleaned:robot group 3-21,average 14.33±5.19;laparoscopic group 1-25,average10.85+5.04.The number of lymph nodes in the robot group was higher than that in the laparoscopic group,P=0.010.Postoperative restoring eating time:robot group 3-17d,mean5.39±1.84d;laparoscopic group 4-20d,average 6.72±2.49d.The robot group was shorter than the laparoscopic group,P=0.036.There was no significant difference in the operation time,bleeding volume,first exhaust time,first defecation time,postoperative hospital stay and postoperative complications between the robot group and the laparoscopic group(P>0.05).(2)In the high rectal Dixon operation,the first exhaust time:robot group 2-4d,average 2.16±0.37d;laparoscopic group 2-4d,average 3.28±0.65d.The first group compared the robot group with the first exhaust time,P=0.032.First defecation time:robot group 2-4d,average 2.91±0.45;laparoscopic group 2-5d,average 3.72±0.77d.The first defecation time of the robot group was earlier,P=0.029.Postoperative dietary recovery time:robot group 6-23d,mean 6.27±2.00 d;laparoscopic group 6-25d,average 7.97±2.43d.The robotic group recovered earlier in the two groups,P=0.031.Catheter removal time:robot group 1-8d,mean 2.59±1.58d;laparoscopic group 2-9d,mean 3.48±1.88d.The time to pull out the catheter was earlier in the robot group,P=0.025.Number of lymph nodes cleaned:robot group 3-28,average 16.24±4.95;laparoscopic group 2-31,average 12.10+6.09.The number of lymph nodes cleaned in the robot group was higher,P=0.001.There was no significant difference in the operation time,bleeding volume,postoperative hospital stay and postoperative complications between the robot group and the laparoscopic group(P>0.05).(3)In the low rectal cancer,the robot group 58 cases,of which40 cases(68.97%)were treated with retaining anal;76 cases were laparoscopic group,40 cases(52.63%)were treated with retaining anal.In the two groups,the robot group has a higher rate in retaining anal,P=0.041.(4)In the colon surgery,the number of lymph nodes was cleaned:robotic group 7-26 pieces,with an average of 18.26±6.56;laparoscopic group 6-20 pieces,with an average of 12.97±6.73 pieces.The number of lymph nodes in the robot group was higher,P=0.001.The operation time:robot group 60-220 min,average 154.94±67.59 min;laparoscopic group 70-240 min,average 130.66±35.35 min.The laparoscopic surgery time was shorter in the two groups,P=0.002.The amount of bleeding,first exhaust time,first defecation time,postoperative dietary recovery time,catheter removal time,postoperative hospital stay,and postoperative complication rate in the robot group were not statistically significant compared with the laparoscopic group(P>0.05).1)Number of lymph nodes removed during sigmoid surgery:robot group 6-36,average 18.06±7.3;laparoscopic group 5-19,average 12.83±3.68.The number of lymph nodes cleaned in the robot group was higher,P=0.001.The operation time:robot group 80-230 min,average 130.59±38.32 min;laparoscopic group 70-160 min,average 100.42±22.91 min.The laparoscopic surgery time was shorter in the two groups,P=0.014.The amount of bleeding,first exhaust time,first defecation time,postoperative dietary recovery time,catheter removal time,postoperative hospital stay,and postoperative complication rate in the robot group were not statistically significant compared with the laparoscopic group(P>0.05).2)In the left colon surgery,the number of lymph nodes was removed:robotic group 5-19,with an average of 18.06±7.30;laparoscopic group 4-21,with an average of 12.83±3.69.The number of lymph nodes in the robot group was higher than that in the laparoscopic group,P=0.028.The operation time,bleeding volume,first exhaust time,first defecation time,postoperative diet recovery time,catheter removal time and postoperative hospital stay days were not significantly different between the robot group and the laparoscopic group(P>0.05).3)In the right colon surgery,the number of lymph nodes was removed:robot group 7-49,average 27±8.85;laparoscopic group 6-33,average 18±9.50.The number of lymph nodes in the robot group was higher than that in the laparoscopic group,P=0.003.The operation time,bleeding volume,first exhaust time,first defecation time,postoperative diet recovery time,catheter removal time and postoperative hospital stay were not significantly different between the two groups(P>0.05).(5)The follow-up time of the robot group was 1-18 months,the median follow-up time was 8 months,the laparoscopic group was followed up for 3-30 months,and the median folow-up time was 9 months.The tumor-free survival rates of the two groups were 92.04%and 92.66%,respectively(P=0.204).Conclusion 1.The Da Vinci robotic surgery system is safe,feasible and effective in the application of colorectal cancer radical surgery.;2.In radical resection of rectal cancer,compared with laparoscopic surgery The Finch robotic surgery system can more clean lymph nodes,remove catheters and early postoperative recovery;3.In the radical surgery of low rectal cancer,the Da Vinci robotic surgery system retains an anal rate higher than the laparoscope and may have more Broad clinical application prospects. |
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