| Objective:To compare the difference and recovery of postoperative anal function in patients with low rectal cancer treated by Da Vinci robot and laparoscopic surgery.Methods:In this study,79 patients with low rectal cancer who underwent robot-assisted or laparoscopic-assisted radical anal preservation surgery for rectal cancer in The Department of Gastrointestinal Surgery of the First Affiliated Hospital of Nanchang University from January 2020 to January 2021 were selected as subjects for retrospective study strictly according to the inclusion and exclusion criteria.Thirty-three patients underwent robotic surgery and 46 patients underwent laparoscopic surgery.The principle of total mesorectal resection(TME)was strictly followed in all surgeries.Perioperative data of the patients were collected: general clinical data,such as gender,age,weight,height,body mass index(BMI),distance from the lower margin of the tumor to the dentate line;Intraoperative and postoperative data: such as estimated intraoperative blood loss,postoperative hospital stay,stoma repayment time,and surgical costs.Postoperative pathological results: such as the number of recovered lymph nodes,the number of positive lymph nodes,tumor TNM stage.Anal function was evaluated 1,3,6,and 12 months after surgery using LARS score scale and Wexner scale in outpatient or telephone follow-up patients or their family members.In patients undergoing ileostomy,evaluation was completed after stomostomy repayment.The LARS score was designed to assess the severity of anal function impairment in low anterior resection syndrome(LARS),including control of exhaust,loose defecation,frequency of defecation,and repeated defecation within a short period of time and urgent defecation.According to LARS score,patients can be divided into three groups: 0 to 20 points,belonging to the LARS free group;21--29 points,belonging to the mild LARS group;30 to 42 points,belonging to the severe LARS group.The Wexner scale used five frequency levels(never,occasionally,sometimes,often,and always)to assess,asking about incontinence in gaseous,liquid,and solid faeces,as well as pad use and lifestyle changes.The lower the score is,the better the anus function is,and the worse it is.The total score is 0,the anus function is normal,≤10 points,the anus function is good,> 10 points,the anus function is not good,and 20 points,the anus function is completely incontinent.Results:General clinical data: there were no significant differences in age,body mass index,distance from lower margin of tumor to dentate line between the robot group and the laparoscopic group(P > 0.05).Intraoperative and postoperative data: There were no significant differences in estimated intraoperative blood loss,postoperative hospitalization days and stoma repayment time between the robot group and the laparoscopic group(P > 0.05).Postoperative pathological results: There were no significant differences in the number of recovered lymph nodes and positive lymph nodes between the robotic group and the laparoscopic group(P > 0.05).The hospitalization cost of the robot group was higher than that of the laparoscopic group [(88785.30±12629.95)yuan vs.(66835.37±7573.45)yuan,P <0.001].Anal function score comparison,at the 1st,3rd,6th and 12 th month after surgery,LARS score of the robot group was lower than that of the laparoscopic group[(34.15±1.70)points vs.(36.57±2.08)points,(24.91±2.08)points vs.(32.87±1.66)points,(16.06 ± 1.62)points vs.(25.93±1.95)points,(4.15±2.15)points vs.(6.20±1.61)points,P < 0.01].Wexner score in the robot group was lower than that in the laparoscopic group at the 1st,3rd,6th and 12 th month after surgery [(12.12±1.73)points vs.(14.11±1.98)points,(7.97±1.74)points vs.(9.80±1.81)points,(4.03±1.57)points vs.(6.91±1.50)points,(2.24±1.34)points vs.(3.28±1.53)points,P < 0.01].Conclusion:In low rectal cancer,Da Vinci robotic surgery has more advantages than laparoscopy surgery in protecting patients’ anal function,and patients’ postoperative anal function recovery is faster and the recovery time to normal anal function is shorter. |
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