BACKGROUND Few investigations to date assessing the effectiveness of robot-assisted intersphincteric resection (ISR) have included sufficient patients and follow-up period. This study assessed the utility and safety of robot-assisted ISR by comparing groups of patients who underwent low anterior resection (LAR) with or without ISR and ISR extent. METHODS This study enrolled 897 patients who underwent curative LAR between 2010 and 2017. Patients were divided into those who did (ISR+) and did not (ISR-) undergo ISR, with the former group subdivided by ISR extent (partial, subtotal, and total). Tumor recurrence and survival were compared in the two groups by one-to-one nearest neighbor matching (218 patients each). RESULTS Robot-assisted ISR was performed via an entirely transabdominal approach in 93% of patients who underwent LAR. The rate of circumferential margin positivity was ≤ 2% in all patients and did not differ in the ISR- and ISR+ groups or in the three ISR+ subgroups. Mean fecal incontinence score and manometric values deteriorated significantly during postoperative until 12-24 months (p < 0.05 to < 0.001), but recovered subsequently. The 5-year cumulative rates of local recurrence in the ISR+ and ISR- groups were 2.5% and 2.9%, respectively (p = 0.731). The 5-year cumulative rates of overall (86.7% vs. 84.2%, p = 0.899) and disease-free (80.7% vs. 78.5%, p = 0.934) survival did not differ significantly in the ISR+ and ISR- groups. CONCLUSIONS Because ISR involves resection of low-lying tumors and complex pelvic dissection, robot-assisted ISR via a mostly transabdominal procedure may be technically more efficient, providing lasting anorectal function and good oncologic outcomes.

中文翻译：

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机器人辅助下括约肌切除术在下直肠癌中的肿瘤学和肛门直肠功能预后，尤其是括约肌切除术的范围和节肢的保存。

背景技术迄今为止，几乎没有评估机器人辅助括约肌间切除术（ISR）有效性的研究包括足够的患者和随访期。这项研究通过比较接受或不采用ISR和ISR程度的低位前切除术（LAR）的患者组，评估了机器人辅助ISR的实用性和安全性。方法：本研究招募了897例在2010年至2017年间接受根治性LAR治疗的患者。患者分为接受（ISR +）和未接受（ISR-）的ISR患者，前一组按ISR程度细分（部分，小计和总计） ）。通过一对一的近邻匹配（每组218例）比较两组的肿瘤复发和生存率。结果93％的LAR患者通过完全腹腔入路进行了机器人辅助ISR。所有患者的外周切缘阳性率均≤2％，在ISR-和ISR +组或三个ISR +亚组中无差异。术后直至12-24个月，平均大便失禁评分和测压值明显下降（p <0.05至<0.001），但随后恢复。ISR +和ISR-组的5年局部复发累积率分别为2.5％和2.9％（p = 0.731）。在ISR +和ISR-组中，5年总生存率（86.7％对84.2％，p = 0.899）和无疾病生存率（80.7％对78.5％，p = 0.934）没有显着差异。结论由于ISR需要切除低洼的肿瘤并进行复杂的骨盆清扫术，因此机器人辅助ISR通过主要是经腹的手术可能在技术上更为有效，