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Comparative Study BJS open. 2024 May 8;8(3):zrae029. doi: 10.1093/bjsopen/zrae029 Q14.52025

Total mesorectal excision in MRI-defined low rectal cancer: multicentre study comparing oncological outcomes of robotic, laparoscopic and transanal total mesorectal excision in high-volume centres

磁共振定义的低位直肠癌全系膜切除：高量级中心机器人、腹腔镜和经肛门全系膜切除术的多中心研究比较了肿瘤结局 翻译改进

Marieke L Rutgers  1, Thijs A Burghgraef  2  3, Jeroen C Hol  1  4, Rogier M Crolla  5, Nanette A van Geloven  6, Jeroen W Leijtens  7, Fatih Polat  8, Apollo Pronk  9, Anke B Smits  10, Jurriaan B Tuyman  1, Emiel G Verdaasdonk  11, Colin Sietses  4, Esther C Consten  2  3, Roel Hompes  1

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作者单位

  • 1 Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
  • 2 Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
  • 3 Department of Surgery, University Medical Centre, Groningen, The Netherlands.
  • 4 Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
  • 5 Department of Surgery, Amphia Hospital, Breda, The Netherlands.
  • 6 Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands.
  • 7 Department of Surgery, Laurentius Hospital, Roermond, The Netherlands.
  • 8 Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
  • 9 Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
  • 10 Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
  • 11 Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands.

    • DOI: 10.1093/bjsopen/zrae029 PMID: 38788679

    摘要 中英对照阅读

    Background: The routine use of MRI in rectal cancer treatment allows the use of a strict definition for low rectal cancer. This study aimed to compare minimally invasive total mesorectal excision in MRI-defined low rectal cancer in expert laparoscopic, transanal and robotic high-volume centres.

    Methods: All MRI-defined low rectal cancer operated on between 2015 and 2017 in 11 Dutch centres were included. Primary outcomes were: R1 rate, total mesorectal excision quality and 3-year local recurrence and survivals (overall and disease free). Secondary outcomes included conversion rate, complications and whether there was a perioperative change in the preoperative treatment plan.

    Results: Of 1071 eligible rectal cancers, 633 patients with low rectal cancer were identified. Quality of the total mesorectal excision specimen (P = 0.337), R1 rate (P = 0.107), conversion (P = 0.344), anastomotic leakage rate (P = 0.942), local recurrence (P = 0.809), overall survival (P = 0.436) and disease-free survival (P = 0.347) were comparable among the centres. The laparoscopic centre group had the highest rate of perioperative change in the preoperative treatment plan (10.4%), compared with robotic expert centres (5.2%) and transanal centres (2.1%), P = 0.004. The main reason for this change was stapling difficulty (43%), followed by low tumour location (29%). Multivariable analysis showed that laparoscopic surgery was the only independent risk factor for a change in the preoperative planned procedure, P = 0.024.

    Conclusion: Centres with expertise in all three minimally invasive total mesorectal excision techniques can achieve good oncological resection in the treatment of MRI-defined low rectal cancer. However, compared with robotic expert centres and transanal centres, patients treated in laparoscopic centres have an increased risk of a change in the preoperative intended procedure due to technical limitations.

    Keywords：total mesorectal excision; low rectal cancer; robotic surgery; laparoscopic surgery; transanal surgery

    背景：MRI在直肠癌症治疗中的常规应用允许对低位癌症使用严格的定义。本研究旨在比较在专家腹腔镜、经肛门和机器人高容量中心进行的MRI定义的低位癌症微创全直肠炎切除术。方法：纳入2015年至2017年间在11个荷兰中心进行的所有MRI定义的癌症手术。主要结局是：R1率、直肠系膜切除总质量和3年局部复发和生存率（总体和无病）。次要结局包括转化率、并发症以及围手术期是否改变了术前治疗计划。结果：在1071例符合条件的直肠癌中，633例为低位癌症患者。各中心间的全直肠系膜切除标本质量（P=0.337）、R1率（P=0.107）、转换率（P=0.344）、吻合口漏率（P=0.942）、局部复发率（P=0.809）、总生存率（P=0.436）和无病生存率（P=0.347）具有可比性。与机器人专家中心（5.2%）和经肛门中心（2.1%）相比，腹腔镜中心组在术前治疗计划中的围手术期变化率最高（10.4%），P=0.004。这种变化的主要原因是缝合困难（43%），其次是肿瘤位置低（29%）。多变量分析显示，腹腔镜手术是改变术前计划手术的唯一独立风险因素，P=0.024。结论：在所有三种微创全直肠炎切除技术方面具有专业知识的中心可以在MRI定义的低位癌症的治疗中实现良好的肿瘤切除。然而，与机器人专家中心和经肛门中心相比，由于技术限制，在腹腔镜中心接受治疗的患者术前预期程序发生变化的风险增加。©作者2024。牛津大学出版社代表BJS基金会有限公司出版。

    关键词：全直肠系膜切除术; 低位直肠癌; 机器人手术; 腹腔镜手术; 经肛门手术

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    ISSN：2474-9842

    e-ISSN：2474-9842

    IF/分区：4.5/Q1

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    Total mesorectal excision in MRI-defined low rectal cancer: multicentre study comparing oncological outcomes of robotic, laparoscopic and transanal total mesorectal excision in high-volume centres