Background: Robot-assisted total mesorectal excision has been proposed as an alternative to laparoscopic TME for rectal cancer. However, its short-term outcomes and long-term oncological efficacy remain debated, especially in Western populations. This study evaluates the short-term clinical and long-term oncological outcomes of robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres. Methods: This multicentre, international, retrospective cohort study included 1390 patients from the EUREKA collaborative dataset who underwent robot-assisted total mesorectal excision for rectal cancer between January 2013 and January 2022. All surgeries were performed by expert surgeons beyond the learning curve. Data were analysed for patient demographics, perioperative outcomes, pathological findings, and three-year survival metrics. Kaplan–Meier analysis was used to evaluate overall and disease-free survival. Results: Of 1390 patients, 60.6% underwent restorative low anterior resection. Conversion to open surgery occurred in 3.7%, and postoperative complications were reported in 28.7%. Anastomotic leakage occurred in 14.7% of patients who underwent restorative low anterior resection. The median operative time was 223 min. R0 resection was achieved in 94.7%, and circumferential resection margin positivity was 5.5%. Three-year overall survival was 90.1%, disease-free survival was 88.6%, and local recurrence was 2.9%. Conclusions: Robot-assisted total mesorectal excision performed by experienced surgeons in high-volume European centres is safe, with low conversion rates, acceptable complication rates, and favourable oncological outcomes. These findings underscore the potential of robot-assisted total mesorectal excision as a standard approach for rectal cancer in specialised settings.
背景：机器人辅助全直肠系膜切除术已被提议作为直肠癌腹腔镜全直肠系膜切除术的替代方案。然而，其短期疗效和长期肿瘤学效果仍存在争议，尤其是在西方人群中。本研究评估了欧洲高手术量中心经验丰富的外科医生实施机器人辅助全直肠系膜切除术的短期临床及长期肿瘤学结果。方法：这项多中心国际回顾性队列研究纳入了EUREKA合作数据集中1390例于2013年1月至2022年1月期间接受机器人辅助全直肠系膜切除术的直肠癌患者。所有手术均由已度过学习曲线的专家外科医生完成。数据分析涵盖患者人口统计学特征、围手术期结果、病理学发现及三年生存指标。采用Kaplan-Meier法评估总生存期和无病生存期。结果：在1390例患者中，60.6%接受了保留功能的低位前切除术。中转开腹率为3.7%，术后并发症发生率为28.7%。接受保留功能低位前切除术的患者中吻合口漏发生率为14.7%。中位手术时间为223分钟。R0切除率达94.7%，环周切缘阳性率为5.5%。三年总生存率为90.1%，无病生存率为88.6%，局部复发率为2.9%。结论：在欧洲高手术量中心由经验丰富的外科医生实施的机器人辅助全直肠系膜切除术是安全的，具有较低的中转开腹率、可接受的并发症发生率及良好的肿瘤学结果。这些发现强调了在专业医疗环境中，机器人辅助全直肠系膜切除术有望成为直肠癌标准治疗方案的潜力。
肿瘤(癌症)患者之家