Background/Objectives: Rectal cancer is a major global health issue with high morbidity and mortality rates. Local recurrence (LR) significantly impacts patient outcomes, decreasing survival rates and often necessitating extensive secondary treatments. While robot-assisted total mesorectal excision (R-TME) is becoming a preferred method for rectal cancer surgery due to its improved precision and visualisation, long-term data on LR and predictors of recurrence remain limited. This study aims to determine the 3-year LR rate following R-TME and to identify predictors of recurrence to enhance patient selection and the personalisation of treatment. Methods: This retrospective international multicentre cohort study included 1039 consecutive rectal cancer patients who underwent R-TME between 2013 and 2020, with a minimum of 3 years of follow-up. Data from tertiary colorectal centres in the United Kingdom, the Netherlands, Spain, France, Italy, and Belgium were analysed. Potential predictors of LR were identified using backward elimination, and four machine learning models were evaluated for predicting LR. Results: The 3-year LR rate was 3.8%. Significant predictors of LR included advanced clinical M-staging, length of the hospital stay, postoperative ileus, postoperative complications, pathological N-staging, the completeness of resection, and the resection margin distance. The eXtreme Gradient Boosting model performed best for LR prediction, with a final accuracy of 77.1% and an AUC of 0.76. Conclusions: R-TME in high-volume centres achieves low 3-year LR rates, suggesting that robot-assisted surgery offers oncological safety and advantages in rectal cancer management. This study underscores the importance of surgical precision, patient selection, and standardised perioperative care, supporting further investment in robotic training to improve long-term patient outcomes.
背景/目的：直肠癌是全球范围内发病率和死亡率均较高的重大健康问题。局部复发（LR）显著影响患者预后，不仅降低生存率，常需进行复杂的二次治疗。机器人辅助全直肠系膜切除术（R-TME）因其更高的精准度和可视化优势，正逐渐成为直肠癌手术的首选方法，但关于LR的长期数据及复发预测因素的研究仍显不足。本研究旨在确定R-TME术后3年LR发生率，并识别复发预测因素，以优化患者选择和个体化治疗方案。方法：这项回顾性国际多中心队列研究纳入了2013年至2020年间连续接受R-TME治疗的1039例直肠癌患者，所有患者均完成至少3年随访。研究分析了来自英国、荷兰、西班牙、法国、意大利和比利时三级结直肠中心的数据。通过后向消除法识别LR的潜在预测因素，并评估了四种机器学习模型对LR的预测效能。结果：3年LR发生率为3.8%。LR的重要预测因素包括：临床M分期晚期、住院时间、术后肠梗阻、术后并发症、病理N分期、切除完整性及切缘距离。极端梯度提升模型在LR预测中表现最佳，最终准确率达77.1%，曲线下面积（AUC）为0.76。结论：在高手术量中心实施R-TME可获得较低的3年LR发生率，表明机器人辅助手术在直肠癌治疗中具有肿瘤学安全性和优势。本研究强调了手术精准度、患者选择和标准化围手术期护理的重要性，支持进一步投入机器人手术培训以改善患者长期预后。
肿瘤(癌症)患者之家