| Background:According to Global Cancer Statistics statistics the incidence of colorectal cancer is 10.0%,which is the third in cancer incidence;the mortality of colorectal cancer is 9.4%,accounting for the second place of cancer mortality.Surgical radical resection is the primary treatment for early or middle stage rectal cancer.This is an effective method to decreases the recurrence rate,raise life quality and prolong life survival.At the appearance of the minimally invasive treatment,the laparoscopic rectal cancer surgery developed rapidly.At the appearance of Da Vinci robotic which has become the dominant of rectal treatment.However,which is better between Da Vinci robotic or laparoscopic in radical resection of rectal cancer has not been proven.Objective:To compared the short-term efficacy of Da Vinci robot and laparoscope in radical resection of rectal cancer.To analyzed the practicability,efficacy and safety of Da Vinci robotic-assisted radical resection for rectal cancer.Methods:To the short-term efficacy,Clinical data of 144 cases of rectal cancer undergoing the Da Vinci robotic-assisted or laparoscope-assisted radical resection for rectal cancer in the department of Gastrointestinal colorectal and anal surgery,CHINA-JAPAN Union Hospital of Jilin University from June 1,2020 to February 10,2022 were collected and analyzed retrospectively.There are 47 patients who received Da Vinci robotic-assisted radical resection of rectal cancer and 97 patients who received laparoscope-assisted radical resection for rectal cancer.To compared the short-time therapeutic effect in the two groups,such as the blood loss during operation,the postoperative exhaust time,the time of feeding liquid food,postoperative complications,the postoperative hospital stay time and number of lymph nodes removed,etc.Result:All patient were successfully complete the minimally invasive surgery,there were no one switched to laparoscopy or laparotomy.The general information of two group: A total of 144 cases of rectal cancer were enrolled in the study,including 90 males and 54 females.The average age is 62±9.9 years old.There were 6（4.2%）patients were received Neoadjuvant chemoradiotherapy,19（13.2%）patients were diagnosed diabetic.The average BMI is 23.9±3.6 kg/㎡.There were not significant difference in age,BMI,gender,whether neoadjuvant chemoradiotherapy,whether diabetes,ASA classification,the distance from the lower margin of the tumor to the anal margin between two groups（P>0.05）.Perioperative conditions :47 patients were undergoing the Da Vinci robotic-assisted radical resection for rectal cancer,including 42 patients performed Dixon,3 patients performed Miles,2 patients performed Noses;97 patients were undergoing the laparoscope-assisted radical resection for rectal cancer.Including 76 patients performed Dixon,8 patients performed Baconn.6 patients performed Miles,4 patients performed Noses,1 patients performed Hartmann.With P<0.05,there is no significant difference in the two groups.Group Da Vinci robotic patients in the intraoperative blood loss was lower than group laparoscopic patients,there was significant difference between two groups（P>0.05）.The blood loss in robotic group was 40（20-60）ml and in laparoscopic group was 50（25-75）ml.The operation time in robotic group was 211（190-250）minutes.It was longer than the operation time 180（150-219）minutes of the laparoscopic group.The robot group was divided into the first 24 cases group（group A）and the last 23 cases group（group B）.Group A’s operation time 250±59minutes was longer than the group B’s 210±30minutes.Significant difference was seen between group A and B（P=0.002<0.05）.The latest 20 case in robot group is setting as group C.The latest 20 case in laparoscopic group is setting as group D.Group C’s operation time 206±32 minutes was longer than the group D’s 187±40 minutes,but there are no significant difference between group C and D（P=0.119>0.05）.There are significant difference in the feeding liquid diet time between two groups（P<0.01）.The patients who have stoma divided into robot group（group E）and laparoscopic group（group F）.And there are no significant difference in feeding liquid food time between group E and F（P=0.558>0.05）.The patients who didn’t have stoma divided into robot group（group G）and laparoscopic group（group H）.Group G’s feeding liquid food time 3（2.5-4）days was shorter than the group H’s 4（3-6）days.Significant difference was seen between group G and H（P=0.006<0.05）.The feeding liquid diet time in robot group was shorter than laparoscopic group（P<0.01）.The NNIS classification,whether enterostomy,postoperative pain,ambulation time,the time of catheters extraction,postoperative exhaust time,postoperative length of stay in the hospital,etc,have no significant difference between two groups（P>0.05）.10（21.3%）patients suffered from complications in robotic group and 22（22.7%）patients suffered from complications in laparoscopic group.There has no significant difference in complication,such as anastomotic leakage.anastomotic bleeding,Dysuria,etc（P>0.05）.The overall cost of hospitalization and operation fee in the robotic group were higher than that in the laparoscopic group,with statistical significance（P<0.01）.The overall cost of hospitalization and operation fee in the robotic group were 37968（37967-40401）yuan and 105349（97714-114659）yuan.The overall cost of hospitalization and operation fee in the laparoscopic group were 11490（10300-12400）yuan and 80338（73061-86830）yuan.In both groups,all patients’ distal resection margin and circumferential resection were negative.The diameter of the tumors,the pathologic patterns,whether has mucinous adenocarcinoma,AJCC staging,the numbers of lymph nodes,weather perineural or vessel invasion were no significant difference between two groups（P>0.05）.Conclusion:Compared with laparoscopic-assisted radical resection for rectal cancer,Da Vinci robotic-assisted radical resection for rectal cancer could achieve similar short-term outcomes.Da Vinci robotic-assisted radical resection is safe and feasible for rectal cancer.The blood loss of Da Vinci robotic-assisted radical resection is lower than group laparoscopic.The feeding liquid diet time of Da Vinci robotic-assisted radical resection is shorter than group laparoscopic.The operation time of da Vinci robotic radical rectal cancer surgery is relatively long,but with the increase of the number of operations,the operation time can be shortened to a level comparable to that of the laparoscopic group The major constraints of Da Vinci robotic-assisted radical resection are higher hospitalization and operation expenses. |
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