Primary rectal adenocarcinoma에서 로봇 절제 수술 : 초기 100예의 단기 치료성적을 통한 향후 전망분석
- 주제(키워드) da Vinci system , Rectal Cancer , Short term outcome
- 발행기관 고려대학교 대학원
- 지도교수 김선한
- 발행년도 2010
- 학위수여년월 2010. 2
- 학위구분 석사
- 학과 일반대학원 의학과
- 세부전공 외과
- 원문페이지 29 p
- 실제URI http://www.dcollection.net/handler/korea/000000021706
- 본문언어 한국어
- 제출원본 000045579556
초록/요약
Background/Hypothesis: Though some limitations of conventional laparoscopy have been overcome by enhanced dexterity of robotic system, few reports have studied robotic surgery in rectal cancer. We evaluated technical feasibility, effectiveness and safety of robotic resection for rectal cancer, using the da Vinci system through an analysis of our initial series of consecutive 100 patients. Materials & Methods: A review of prospectively collected database at our institute from July 2007 to July 2009 revealed series of 100 consecutive robotic-assisted resections for rectal cancer. Clinicopathologic characteristics and surgical outcomes were analyzed. Results: All operations were performed successfully without open or laparoscopic conversion. Preoperative RT was performed in 15 patients. There were 74 low anterior resections (RoLAR), 4 ultra-low anterior resections (RoULAR), 17 intersphincteric resections (RoISR) and 5 abdomino-perineal resections (RoAPR) with total mesorectal excision. TNM stages were as following; Tis:T1:T2:T3:T4=3:7:25:64:1, N0:N1:N2=63:24:13, M0:M1=96:4. A totally robotic approach was utilized except in early 7 cases. Splenic flexure mobilization was performed in 33 cases. Mean operation and console time were 299.4 (±68.2) and 150.9 (±53.1) minutes. There were 17 postoperative morbidities that include 6 anastomotic leakages, 7 postoperative ileus and 1 voiding difficulty. None had postoperative mortality. First flatus was noted on postoperative day 2.0 (±1.0), diet was started on postoperative day 2.3 (±1.5) and mean postoperative hospital stay was 13.7 (±29.8) days. Mean number of retrieved lymph nodes was 21.0 (±12.0). One specimen showed microscopic tumor involvement in distal resection margin (<0.1mm), and 2 cases showed positive circumferential margin. Mean follow-up period was 9.3 months (±5.9). Locoregional recurrence developed in 3 patients and distant metastasis in 2 patients, of which 1 patient had both. Conclusions. This study demonstrated that totally robotic resection with total mesorectal excision and splenic flexure mobilization can be applied safely and effectively for patients with rectal cancer. Keywords: da Vinci system, Rectal Cancer, Short term outcome
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