对已有结肠造口术的患者进行新辅助治疗后,采用机器人括约肌保留手术治疗直肠癌的可行性和疗效。

IF 2.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-08-13 DOI:10.1007/s10151-024-02980-w
H Nozawa, A Sakamoto, K Murono, K Sasaki, S Emoto, S Ishihara
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引用次数: 0

摘要

背景:阻塞性直肠癌的首选治疗方法是进行分流结肠造口术,然后进行新辅助治疗。与传统的腹腔镜手术相比,机器人手术治疗这类患者具有多项优势。相反,现有的造口可能会干扰最佳套管位置,从而影响机器人手术的质量。此外,控制台外科医生不能面对病人,这可能会危及造口:方法:对本院接受新辅助治疗后使用机器人平台进行保留括约肌手术的直肠癌患者进行了回顾性调查。根据治疗前造口情况,将患者分为 NS 组(无造口患者)和 S 组(有造口患者)。比较两组患者的基线特征、新辅助治疗类型、短期手术效果、术后肛门直肠测压数据和存活率:结果:NS组和S组分别有65名和9名患者。NS组有3名患者需要转为开腹手术。S组所需的控制台时间长于NS组(中位数分别为367分钟和253分钟,P = 0.038);但在手术总时间(P = 0.15)和失血量(P = 0.70)方面未观察到差异。两组患者的术后并发症发生率、肛门直肠功能和肿瘤结果相似:虽然有造口患者的控制台时间较长,但机器人手术与新辅助治疗后无造口者的手术一样安全。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Feasibility and outcomes of robotic sphincter-preserving surgery for rectal cancer after neoadjuvant treatment in patients with preexisting colostomy.

Background: Diverting colostomy followed by neoadjuvant treatment is a treatment of choice for obstructive rectal cancer. Such patients may be treated via a robotic approach with several advantages over conventional laparoscopic surgery. Conversely, the existing stoma may interfere with the optimal trocar position and thus affect the quality of robotic surgery. Moreover, the console surgeon does not face the patient, which may endanger the stoma.

Methods: Patients with rectal cancer who underwent sphincter-preserving surgery were retrospectively investigated using a robotic platform after neoadjuvant treatment at our hospital. Based on pretreatment stoma creation, patients were divided into the NS (those without a stoma) and S groups (patients with a stoma). Baseline characteristics, types of neoadjuvant treatment, short-term surgical outcomes, postoperative anorectal manometric data, and survival were compared between the groups.

Results: The NS and S groups comprised 65 and 9 patients, respectively. Conversion to laparotomy was required in three patients in the NS group. The S group required a longer console time than the NS group (median: 367 vs. 253 min, respectively, p = 0.038); however, no difference was observed in the total operative time (p = 0.15) and blood loss (p = 0.70). Postoperative complication rates, anorectal function, and oncological outcomes were similar between the groups.

Conclusions: Although console time was longer in patients with a stoma, robotic surgery could be performed safely like in those without a stoma after neoadjuvant treatment.

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来源期刊
Techniques in Coloproctology
Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY
CiteScore
5.30
自引率
9.10%
发文量
176
审稿时长
1 months
期刊介绍: Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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