目的：对比达芬奇机器人与腹腔镜应用于直肠癌全系膜切除术（Total mesorectal excision，TME）的近期疗效。方法：回顾性分析2019 年1 月~2019 年12 月甘肃省人民医院肛肠科235 例行直肠癌全系膜切除术患者的临床资料，其中机器人组120 例，腹腔镜组115 例，比较两组患者的手术情况、术后恢复情况、术后并发症及肿瘤学结果。结果：与腹腔镜组相比，机器人组出血量少[（123.7±103.4）ml Vs （167.2±118.5）ml；t=-2.999，P=0.003]，通气时间短[（79.2±22.9）h Vs （118.3±28.1）h；t=-11.762，P<0.001]，进食流质饮食时间短[（91.0±16.8）h Vs （123.0±21.0）h；t=-12.968，P<0.001]， 腹腔引流量少[（315.4±282.8）ml Vs （397.0±327.9）ml；t=-2.045，P=0.042]，术后住院时间短[（8.1±2.6）d Vs （8.9±2.5）d；t=-2.406，P=0.017]。然而，机器人组住院总费用高于腹腔镜组[（80 193.9±14 934.2）元Vs（65 791.0±17 399.0）元；t=6.823，P<0.001]。两组手术时间、淋巴结清扫、腹腔引流管留置时间、术后并发症和肿瘤学结果的差异无统计学意义。结论：相比于腹腔镜手术，机器人手术出血量少、住院时间短、术后胃肠道功能恢复快，可作为直肠癌TME 手术治疗的有效途径之一。

Objective: To compare the short-term outcomes of conventional laparoscopic total mesorectal excision (L-TME) and robot-assisted total mesorectal excision (R-TME) on rectal cancer. Methods: A total of 235 patients underwent R-TME (120) or L-TME (115) after diagnosed with rectal cancer from January 2019 to December 2019 were included in this study. Patients’ characteristics, perioperative characteristics and pathologic characteristics were evaluated between the R-TME group and the L-TME group. Results: Compared with the L-TME group, the R-TME group showed less intraoperative blood loss (123.7ml Vs 167.2ml, P=0.003), less first flatus time (79.2h Vs 118.3h, P<0.001), less first liquid diet time (91.0h Vs 123.0h, P<0.001), less volume of abdominal drainage (315.4ml Vs 397.0ml, P=0.042) and shorter hospital stay (8.1d Vs 8.9d, P=0.017) . However, the R-TME group had more expensive total hospitalization costs (80 193.9CNY Vs 65 791.0CNY, P<0.001). No significant differences were observed between the two groups in respect to operation time, total number of examined lymph nodes, time of abdominal drainage and postoperative complications. The pathologic characteristics of the two groups were not significantly different. Conclusion: This study shows that the robot-assisted total mesorectal excision is superior to laparoscopic one in terms of short-term outcomes in surgeries of rectal cancer, it is safe and feasible to treat rectal cancer.

收稿日期：2020-02-29 录用日期：2020-06-22

Received Date: 2020-02-29 Accepted Date: 2020-06-22

基金项目：甘肃省自然科学基金（18JR3RA055）；甘肃省青年科技基金（17JR5RA031）；甘肃省卫健委项目（GSWSKY-2019-69）；甘肃省人民医院科研基金（18GSSY1-2；20GSSY1-6；20GSSY3-1；20GSSY4-9）；兰州市科技发展指导性计划（2017-ZD-42）

Foundation Item: Natural Science Foundation of Gansu (18JR3RA055); Youth Science and Technology Foundation of Gansu(17JR5RA031); Project of Health Commission of Gansu Province (GSWSKY-2019-69); Natural Science Foundation of Gansu Provincial Hospital (18GSSY1-2, 20GSSY1-6, 20GSSY3-1, 20GSSY4-9); Science and Technology Development Guiding Project of Lanzhou(2017-ZD-42)

通讯作者：杨熊飞，Email：XiongfeiYang2016@163.com

Corresponding Author: Yang Xiongfei, Email: XiongfeiYang2016@163. com

引用格式：王赫，刘志鹏，李晶晶，等. 机器人与腹腔镜直肠癌TME 手术的近期疗效对照研究[J]. 机器人外科学杂志，2020，1（5）：317-326.

Citation: WANG H, LIU Z P, LI J J, et al. Comparative study on short-term outcomes of robot-assisted and laparoscopic total mesorectal excision (TME) on rectal cancer: results of a single center in Gansu province [J]. Chinese Journal of Robotic Surgery, 2020, 1(5): 317-326.

[1] Crippa J, Grass F, Dozois E J, et al. Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach: Results from a Large Retrospective Cohort [J]. Ann Surg, 2020, Feb 14. 

[2] DAI J, YU Z. Comparison of Clinical Efficacy and Complications Between Laparoscopic Versus Open Surgery for Low Rectal Cancer [J]. Comb Chem High Throughput Screen, 2019, 22(3): 179-186. 

[3] Stevenson A R, Solomon M J, Lumley J W, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial [J]. JAMA, 2015, 314(13): 1356-1363. 

[4] Weber P A, Merola S, Wasielewski A, et al. Teleroboticassisted laparoscopic right and sigmoid colectomies for benign disease [J]. Dis Colon Rectum, 2002, 45(12): 1689-1694, discussion 1695-1696. 

[5] Nakanishi R, Yamaguchi T, Akiyoshi T, et al. Laparoscopic and robotic lateral lymph node dissection for rectal cancer [J]. Surg Today, 2020, 50(3): 209-216. 

[6] Ramji K M, Cleghorn M C, Josse J M, et al. Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center [J]. Surg Endosc, 2016, 30(4): 1337-1343. 

[7] Bedirli A, Salman B, Yuksel O. Robotic Versus Laparoscopic Resection for Mid and Low Rectal Cancers [J]. JSLS, 2016, 20(1): 36-44. 

[8] Debakey Y, Zaghloul A, Farag A, et al. Robotic- Assisted versus Conventional Laparoscopic Approach for Rectal Cancer Surgery, First Egyptian Academic Center Experience, RCT [J]. Minim Invasive Surg, 2018, 28(19): 49-52. 

[9] Ielpo B, Duran H, Diaz E, et al. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs [J]. Int J Colorectal Dis, 2017, 32(10): 1423-1429. 

[10] Miskovic D, Foster J, Agha A, et al. Standardization of laparoscopic total mesorectal excision for rectal cancer: a structured international expert consensus [J]. Ann Surg, 2015, 261(4): 716-722. 

[11] Panteleimonitis S, Harper M, Hall S, et al. Precision in robotic rectal surgery using the Da Vinci Xi system and integrated table motion, a technical note [J]. J Robot Surg, 2018, 12(3): 433-436. 

[12] ZHU X L, YAN PJ, YAO L, et al. Comparison of Short-Term Outcomes Between Robotic-Assisted and Laparoscopic Surgery in Colorectal Cancer [J]. Surg Innov, 2019, 26(1): 57-65. 

[13] Yamaguchi T, Kinugasa Y, Shiomi A, et al. Roboticassisted Vs conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center [J]. Surg Today, 2016, 46(8): 957-962. 

[14] Law W L, Foo Dominic C C. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer [J]. Surg Endosc, 2017, 31(7): 2798-2807. 

[15] Jimenez-rodriguez R M, Rubio-dorado-manzanares M, Diaz-pavon J M, et al. Learning curve in robotic rectal cancer surgery: current state of affairs [J]. Int J Colorectal Dis, 2016, 31(12): 1807-1815. 

[16] Shiomi A, Kinugasa Y, Yamaguchi T, et al. Robotassisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes [J]. Int J Colorectal Dis, 2016, 31(10): 1701- 1710. 

[17] D’annibale A, Pernazza G, Monsellato I, et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer [J]. Surg Endosc, 2013, 27(6): 1887-1895. 

[18] LIU W H, YAN P J, HU D P, et al. Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study[J]. Am Surg, 2019, 85(3): 294-302. 

[19] Panteleimonitis S, Ahmed J, Ramachandra M, et al. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study [J]. Int J Colorectal Dis, 2017, 32(2): 241-248. 

[20] Kim J Y, Kim N K, Lee K Y, et al. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery [J]. Ann Surg Oncol, 2012, 19(8): 2485-2493. 

[21] de Jesus J P, Valadão M, de Castro Araujo R O, et al. The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer[J]. Eur J Surg Oncol, 2016, 42(6): 808-812. 

[22] Katsuno H, Hanai T, Masumori K, et al. Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature [J]. J Anus Rectum Colon, 2020, 4(1): 14-24. 

[23] Matsuyama T, Kinugasa Y, Nakajima Y, et al. Roboticassisted surgery for rectal cancer: Current state and future perspective [J]. Ann Gastroenterol Surg, 2018, 2(6): 406-412.