文章：

机器人手术在胃肠道恶性肿瘤中的应用——胰腺癌、胃癌、肝癌及结直肠癌手术进展综述

Robotic Surgery for Gastrointestinal Malignancies—A Review of How Far Have We Come in Pancreatic, Gastric, Liver, and Colorectal Cancer Surgery

原文发布日期：27 November 2025

DOI: 10.3390/cancers17233802

类型: Article

开放获取: 是

英文摘要：

Introduction: Robotic-assisted surgery offers technological advantages such as three-dimensional visualization and improved dexterity, yet its clinical adoption in gastrointestinal (GI) malignancies is supported by evidence of varying quality, consisting mainly of retrospective studies. This review provides a structured summary of the current evidence for robotic surgery in pancreatic, gastric, liver, and colorectal cancers. Methods: A comprehensive literature review was conducted to assess and summarize the perioperative, long-term, and oncological outcomes of robotic-assisted surgery compared to laparoscopic and open approaches for the aforementioned GI malignancies. Results: The application of the robotic platform is most advanced in colorectal surgery. High-quality evidence for rectal cancer demonstrates improved quality of mesorectal specimens, better preservation of urinary and sexual function, and lower local recurrence rates. Across all reviewed GI malignancies, robotic surgery consistently shows advantages in lower conversion-to-open rates, reduced intraoperative blood loss, and shorter hospital stays, though it is associated with longer operative times and higher costs. The evidence for pancreatic and liver surgery is less mature due to the complexity of these procedures. Data for gastric surgery suggests improved lymph node retrieval and, in one long-term study, better disease-free survival. Conclusions: The highest-quality evidence supports the robotic approach for rectal cancer, showing clear functional and oncological benefits. While several perioperative advantages are consistently reported across all GI sites, robust data demonstrating superior long-term survival are still limited for most procedures.

摘要翻译： 

引言：机器人辅助手术具备三维可视化与操作灵活性等技术优势，但其在胃肠道恶性肿瘤领域的临床应用证据质量参差不齐，主要基于回顾性研究。本综述系统梳理了当前机器人手术在胰腺癌、胃癌、肝癌及结直肠癌领域的循证依据。方法：通过全面文献回顾，比较机器人辅助手术与腹腔镜及开腹手术在上述胃肠道恶性肿瘤中的围手术期、长期预后及肿瘤学结局。结果：机器人平台在结直肠外科领域应用最为成熟。高质量证据表明，直肠癌机器人手术可提升全直肠系膜切除标本质量，更好地保护泌尿及性功能，并降低局部复发率。在所有纳入研究的胃肠道恶性肿瘤中，机器人手术在降低中转开腹率、减少术中失血量和缩短住院时间方面展现持续优势，但存在手术时间延长及费用较高的局限性。由于手术复杂性，胰腺与肝脏手术的循证依据尚不充分。胃癌手术数据显示淋巴结清扫数量有所改善，一项长期研究提示其可提高无病生存率。结论：现有最高质量证据支持机器人手术在直肠癌治疗中的应用，其功能保护与肿瘤学获益明确。尽管各胃肠道部位均报告了多项围手术期优势，但对于多数术式而言，能证实其长期生存获益的强有力数据仍显不足。

原文链接：

Robotic Surgery for Gastrointestinal Malignancies—A Review of How Far Have We Come in Pancreatic, Gastric, Liver, and Colorectal Cancer Surgery