Robotic Colorectal Cancer Surgery - Early Experience at a Single Center

Purpose. Colorectal cancer is the most prevalent malignancy in Taiwan. Surgical resection is the key to cure this disease and laparoscopic technique is widely adopted. Recently, robotic surgery has also gained popularity. This study reports our early experience with robotic surgery for rectal cancer. Methods. Data of consecutive patients who underwent robotic proctectomy between Mar. 2012 and Jan. 2013 were retrospectively reviewed. Baseline demographic, intra-operative, and post-operative data were collected. Numerical data were reported as mean ± standard deviation, or median (range). Survival curve was analyzed by Kaplan-Meier estimator, and stratified by tumor stage and neoadjuvant chemo-radiation therapy status. Results. Fifty patients with rectal cancer were included. Baseline demographic data were similar to those of general population with rectal cancer. Six patients were obese (12%). Twenty-two lower rectal lesions were treated with total mesorectal excision. Mean operation time was 283±61 min for total mesorectal excision and 342±69 min for abdominoperineal resection. No conversion was necessary. Two intra-operative small bowel injuries (4%) occurred, and five post-operative complications (10%) needed surgical intervention. The number of retrieved lymph nodes was 15±7 in neoadjuvant chemo-radiation therapy group and 24±10 in non-neoadjuvant chemo-radiation therapy group, and no circumferential resection margin involvement was detected. The out-of-pocket cost of robotic proctectomy was NT$ 181,500±3000. Fiver-year survival was ＞ 90% for stage 1/2 rectal cancer and 60% for stage 3 cancer. Conclusions. Application of da Vinci robotic system in rectal cancer surgery yields acceptable short-term and long-term results.

關鍵字

Robotic surgery ； Total mesorectal excision ； Neoadjuvant concurrent chemo-radiation therapy

並列摘要

目的：大腸直腸癌是台灣盛行率最高的惡性腫瘤，手術切除是治癒之關鍵，腹腔鏡技術已被廣泛使用，而近年機器手臂手術也日益普及，本研究報告本院機器手臂手術使用於直腸癌的早期經驗。方法：我們回溯性收集連續於2012年三月至2013年一月，接受機器手臂直腸切除之患者資料；基本人口學資料、術中、術後資料皆分別收集，數值資料以平均標準差±標準差，抑或中位數（範圍）呈現，存活曲線則是依照期別以及是否接受過術前輔助同步化放療分層，以Kaplan Meier計算式分析。結果：研究共納入了50位病患，基本人口學資料與全國直腸癌患者相近，其中有6位肥胖患者（12%），22個低位直腸癌接受括約肌保留的全直腸繫膜切除，平均手術時間全直腸繫膜切除為283±61分鐘，腹部會陰聯合切除為342±69分鐘，沒有需要改剖腹的案例，有2例（4%）發生術中小腸損傷，另外有5例（10%）發生需要手術治療之術後併發症。淋巴結採樣數目，有接受過術前輔助同步化放療者為15±7，而未接受過術前輔助同步化放療者為24±10，案例皆無環狀切除邊界之侵犯。機器手臂自費金額為新台幣181,500±3000元。第1／2期病患之五年存活率＞90％，而第3期則為60%。結論：達文西機器手臂手術應用在直腸癌手術，其短期及長期結果為可接受的。

並列關鍵字

機器手臂手術；全直腸繫膜切除；術前輔助同步化放療

參考文獻

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Robotic Colorectal Cancer Surgery - Early Experience at a Single Center

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