Jianmin Xu1, Bo Tang2, Taiyuan Li3, Baoqing Jia4, Hongliang Yao5, Ren Zhao6, Weitang Yuan7, Ming Zhong8, Pan Chi9, Yanbing Zhou10, Xiongfei Yang11, Longwei Cheng12, Yulong He13, Yongxiang Li14, Weidong Tong15, Xuejun Sun16, Zhiwei Jiang17, Kang Wang18, Xiaorong Li19, Xin Wang20, Ye Wei21, Zongyou Chen22, Xiaoqiao Zhang23, Yingjiang Ye24, Fanghai Han25, Kaixiong Tao26, Dalu Kong27, Ziqiang Wang28, Cheng Zhang29, Guodong He21, Qingyang Feng21. 1. Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. xujmin@aliyun.com. 2. The First Hospital Affiliated to Army Medical University (Southwest Hospital), Chongqing, People's Republic of China. 3. The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China. 4. Chinese PLA General Hospital, Beijing, People's Republic of China. 5. The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China. 6. Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. 7. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China. 8. Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. 9. Fujian Medical University Union Hospital, Fuzhou, People's Republic of China. 10. The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China. 11. Gansu Provincial People's Hospital, Lanzhou, People's Republic of China. 12. Jilin Cancer Hospital, Changchun, People's Republic of China. 13. The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China. 14. The First Affiliated Hospital of Anhui Medical College, Hefei, People's Republic of China. 15. Daping Hospital, Army Medical University, Chongqing, People's Republic of China. 16. The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China. 17. Jiangsu Province Hospital of Chinese Medicine, Nanjing, People's Republic of China. 18. Sichuan Provincial People's Hospital, Chengdu, People's Republic of China. 19. The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China. 20. Peking University First Hospital, Beijing, People's Republic of China. 21. Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. 22. Huashan Hospital, Fudan University, Shanghai, People's Republic of China. 23. The 960th Hospital of the PLA Joint Logistic Support Force (former Jinan Military General Hospital), Jinan, People's Republic of China. 24. Peking University People's Hospital, Beijing, People's Republic of China. 25. Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China. 26. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China. 27. Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China. 28. West China Hospital, Sichuan University, Chengdu, People's Republic of China. 29. The General Hospital of Northern Theater Command (former the General Hospital of Shenyang Military), Shenyang, People's Republic of China.
Abstract
BACKGROUND: Robotic colorectal cancer surgery is widely accepted and applied. However, there is still no objective and comprehensive assessment on the data of nationwide multicenter series. METHOD: A total of 28 medical centers in Mainland China participated in this nationwide retrospective observational study. From the first case performed in each center to the last until December 2017, patients with robotic resection for primary tumor and pathologically confirmed colorectal adenocarcinoma were consecutively enrolled. Clinical, pathological and follow-up data were collected and analyzed. RESULTS: A total of 5389 eligible patients were finally enrolled in this study, composing 72.2% of the total robotic colorectal surgery volume of Mainland China in the same period. For resections of one bowel segment of primary tumor, the postoperative mortality rate was 0.08% (4/5063 cases), and the postoperative complication rate (Clavien-Dindo grade II or higher) was 8.6% (434/5063 cases). For multiple resections, the postoperative mortality rate was 0.6% (2/326 cases), and the postoperative complication rate was 16.3% (53/326 cases). Out of 2956 patients receiving sphincter-preserving surgery in only primary resection, 130 (4.4%) patients had anastomotic leakage. Traditional low anterior resection (tumor at middle rectum) (OR 2.384, P < 0.001), traditional low anterior resection (tumor at low rectum) (OR 1.968, P = 0.017) and intersphincteric resection (OR 5.468, P = 0.006) were significant independent risk factors for anastomotic leakage. Female gender (OR 0.557, P = 0.005), age ≥ 60 years (OR 0.684, P = 0.040), and preventive stoma (OR 0.496, P = 0.043) were significant independent protective factors. Body mass index, preoperative chemotherapy/radiotherapy, tumor size, and TNM stage did not independently affect the occurrence of anastomotic leakage. CONCLUSION: Robotic colorectal cancer surgery was safe and reliable and might have advantages in patients at high risk of anastomotic leakage.
BACKGROUND: Robotic colorectal cancer surgery is widely accepted and applied. However, there is still no objective and comprehensive assessment on the data of nationwide multicenter series. METHOD: A total of 28 medical centers in Mainland China participated in this nationwide retrospective observational study. From the first case performed in each center to the last until December 2017, patients with robotic resection for primary tumor and pathologically confirmed colorectal adenocarcinoma were consecutively enrolled. Clinical, pathological and follow-up data were collected and analyzed. RESULTS: A total of 5389 eligible patients were finally enrolled in this study, composing 72.2% of the total robotic colorectal surgery volume of Mainland China in the same period. For resections of one bowel segment of primary tumor, the postoperative mortality rate was 0.08% (4/5063 cases), and the postoperative complication rate (Clavien-Dindo grade II or higher) was 8.6% (434/5063 cases). For multiple resections, the postoperative mortality rate was 0.6% (2/326 cases), and the postoperative complication rate was 16.3% (53/326 cases). Out of 2956 patients receiving sphincter-preserving surgery in only primary resection, 130 (4.4%) patients had anastomotic leakage. Traditional low anterior resection (tumor at middle rectum) (OR 2.384, P < 0.001), traditional low anterior resection (tumor at low rectum) (OR 1.968, P = 0.017) and intersphincteric resection (OR 5.468, P = 0.006) were significant independent risk factors for anastomotic leakage. Female gender (OR 0.557, P = 0.005), age ≥ 60 years (OR 0.684, P = 0.040), and preventive stoma (OR 0.496, P = 0.043) were significant independent protective factors. Body mass index, preoperative chemotherapy/radiotherapy, tumor size, and TNM stage did not independently affect the occurrence of anastomotic leakage. CONCLUSION: Robotic colorectal cancer surgery was safe and reliable and might have advantages in patients at high risk of anastomotic leakage.
Authors: Maria MacDonald; Alison Greene; Mark Borgaonkar; Nicholas A Fairbridge; Jerry McGrath; Chris Smith; Chantae Garland; Lisa Bacque; David Pace Journal: Surg Endosc Date: 2022-01-18 Impact factor: 3.453