臨床外科77巻2号

2022年02月発行

特集 ガイドラインには書いていない 大腸癌外科治療のCQ—妥当な治療と適応を見直そう

ロボット支援下直腸癌手術は腹腔鏡下手術よりも推奨されるのか

著者： 島野瑠美¹ 絹笠祐介¹

所属機関： ¹東京医科歯科大学消化管外科学分野

ページ範囲：P.162 - P.166

【ポイント】
◆直腸癌におけるロボット支援下手術は腹腔鏡下手術に対して安全に施行でき，一部の先進的な施設からは良好な成績も報告されており，推奨される術式である．
◆ロボット支援下手術は直腸癌において安全に，より術後合併症を少なくすることができる可能性がある．
◆ロボット支援下手術は困難症例において，より従来の腹腔鏡下手術と比べて有用である．
◆ロボット支援下手術は腹腔鏡よりも習得までの期間が短く，術中教育システムも優れている．

参考文献

1）松山貴俊，絹笠祐介，徳永正則，他：Ⅳ．ロボット支援下直腸手術の現状と未来 大腸外科領域における鏡視下手術の最前線（ロボットを含む）．日本大腸肛門病会誌72：567-574，2019

2）Jayne D, Pigazzi A, Marshall H, et al：Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer：The ROLARR Randomized Clinical Trial. JAMA 318：1569-1580, 2017

3）Yamaguchi T, Kinugasa Y, Shiomi A, et al：Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer：short-term outcomes at a single center. Surg Today 46：957-962, 2016

4）Matsuyama T, Endo H, Yamamoto H, et al：Outcomes of robotic-assisted versus conventional laparoscopic low anterior resection in patients with rectal cancer：a propensity-matched analysis of the National Clinical Database in Japan. BJS Open, 2021 〔DOI：10.1093/bjsopen/zrab083〕

5）Wang Y, Liu Y, Han G, et al：The severity of postoperative complications after robotic versus laparoscopic surgery for rectal cancer：A systematic review, meta-analysis and meta-regression. PLoS One 15：e0239909, 2020

6）Luca F, Valvo M, Ghezzi TL, et al：Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257：672-678, 2013

7）Lee SH, Lim S, Kim JH, et al：Robotic versus conventional laparoscopic surgery for rectal cancer：systematic review and meta-analysis. Ann Surg Treat Res 89：190-201, 2015

8）Broholm M, Pommergaard HC, Gogenur I：Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction：a systematic review and meta-analysis. Colorectal Dis 17：375-381, 2015

9）Kim HJ, Choi GS, Park JS, et al：The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer：a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis 20：O103-O113, 2018

10）D'Annibale A, Pernazza G, Monsellato I, et al：Total mesorectal excision：a comparison of oncological and func-tional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27：1887-1895, 2013

11）Wang G, Wang Z, Jiang Z, et al：Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 13：e1725, 2017

12）Qiu H, Yu D, Ye S, et al：Long-term oncological outcomes in robotic versus laparoscopic approach for rectal cancer：A systematic review and meta-analysis. Int J Surg 80：225-230, 2020

13）Yamaguchi T, Kinugasa Y, Shiomi A, et al：Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer：results of a single high-volume center in Japan. Int J Colorectal Dis 33：1755-1762, 2018

14）Mesquita-Neto JWB, Mouzaihem H, Macedo FIB, et al：Perioperative and oncological outcomes of abdominoperineal resection in the prone position vs the classic lithotomy position：a systematic review with meta-analysis. J Surg Oncol 119：979-986, 2019

15）Kasai S, Kagawa H, Shiomi A, et al：Advantages of robotic abdominoperineal resection compared with laparoscopic surgery：a single-center retrospective study. Surg Today. 2021

16）Lee SH, Kim DH, Lim SW：Robotic versus laparoscopic intersphincteric resection for low rectal cancer：a systematic review and meta-analysis. Int J Colorectal Dis 33：1741-1753, 2018

17）Morohashi H, Sakamoto Y, Miura T, et al：Short-term outcomes of robotic-assisted laparoscopic versus laparoscopic lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 35：5001-5008, 2021

18）Song SH, Choi GS, Kim HJ, et al：Long-term clinical outcomes of total mesorectal excision and selective lateral pelvic lymph node dissection for advanced low rectal cancer：a comparative study of a robotic versus laparoscopic approach. Tech Coloproctol 25：413-423, 2021

19）Yamaguchi T, Kinugasa Y, Shiomi A, et al：Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 32：4498-4505, 2018

20）Hino H, Yamaguchi T, Kinugasa Y, et al：Robotic-assisted multivisceral resection for rectal cancer：short-term outcomes at a single center. Tech Coloproctol 21：879-886, 2017

21）Shin US, Nancy You Y, Nguyen AT, et al：Oncologic Outcomes of Extended Robotic Resection for Rectal Cancer. Ann Surg Oncol 23：2249-2257, 2016

22）大腸癌研究会：大腸癌治療ガイドライン　医師用2019年版〔http://www.jsccr.jp/guideline/2019/index_guide.html〕

23）Park SY, Lee SM, Park JS, et al：Robot Surgery Shows Similar Long-term Oncologic Outcomes as Laparoscopic Surgery for Mid/Lower Rectal Cancer but Is Beneficial to ypT3/4 After Preoperative Chemoradiation. Dis Colon Rectum 64：812-821, 2021

24）Hellan M, Ouellette J, Lagares-Garcia JA, et al：Robotic Rectal Cancer Resection：A Retrospective Multicenter Analysis. Ann Surg Oncol 22：2151-2158, 2015

25）Gorgun E, Ozben V, Costedio M, et al：Robotic versus conventional laparoscopic rectal cancer surgery in obese patients. Colorectal Dis 18：1063-1071, 2016

26）Baukloh JK, Reeh M, Spinoglio G, et al：Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol 43：1304-1311, 2017

27）Panteleimonitis S, Pickering O, Abbas H, et al：Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparosco-py：a comparative propensity scored match study. Int J Colorectal Dis 33：1079-1086, 2018

28）Bayraktar O, Aytac E, Ozben V, et al：Does Robot Over-come Obesity-related Limitations of Minimally Invasive Rectal Surgery for Cancer? Surg Laparosc Endosc Percutan Tech 28：e8-e11, 2018

29）Shiomi A, Kinugasa Y, Yamaguchi T, et al：Robot-assist-ed versus laparoscopic surgery for lower rectal cancer：the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31：1701-1710, 2016

30）Crippa J, Grass F, Achilli P, et al：Risk factors for conversion in laparoscopic and robotic rectal cancer surgery. Br J Surg 107：560-566, 2020

31）Quijano Y, Nuñez-Alfonsel J, Ielpo B, et al：Robotic versus laparoscopic surgery for rectal cancer：a comparative cost-effectiveness study. Tech Coloproctol 24：247-254, 2020

32）Morgan MS, Shakir NA, Garcia-Gil M, et al：Single-versus dual-console robot-assisted radical prostatectomy：impact on intraoperative and postoperative outcomes in a teaching institution. World J Urol 33：781-786, 2015

33）Park IJ, Choi GS, Lim KH, et al：Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13：275-281, 2009

34）Ito M, Sugito M, Kobayashi A, et al：Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23：403-408, 2009

35）Park EJ, Kim CW, Cho MS, et al：Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer：3-phase learning process comparison. Surg Endosc 28：2821-2831, 2014

36）Yamaguchi T, Kinugasa Y, Shiomi A, et al：Learning curve for robotic-assisted surgery for rectal cancer：use of the cumulative sum method. Surg Endosc 29：1679-1685, 2015

37）Odermatt M, Ahmed J, Panteleimonitis S, et al：Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections：a cumulative sum analysis. Surg Endosc 31：4067-4076, 2017

38）Noh GT, Han M, Hur H, et al：Impact of laparoscopic surgical experience on the learning curve of robotic rectal cancer surgery. Surg Endosc. 2020