BACKGROUND Conversion from laparoscopic to open access colorectal surgery is associated with a poorer postoperative outcome. The aim of this study was to assess conversion rates and outcomes after standard laparoscopic rectal resection (LR) and robotic laparoscopic rectal resection (RR). METHODS A national 5-year cohort study utilizing prospectively recorded data on patients who underwent elective major laparoscopic resection for rectal cancer. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry. Primary end point was conversion rate. Secondary end points were postoperative complications within 30 days and histopathological results. Chi-square test, two-sided T test, and Mann-Whitney U test were used for univariable analyses. Both univariable and multivariable logistic regression analyses were used to analyze the relations between different predictors and outcomes, and propensity score matching was performed to address potential treatment assignment bias. RESULTS A total of 1284 patients were included, of whom 375 underwent RR and 909 LR. Conversion rate was 8 out of 375 (2.1%) for RR compared with 87 out of 909 (9.6%) for LR (p < 0.001). RR was associated with reduced risk for conversion compared with LR (aOR 0.22, 95% CI 0.10-0.46). There were no other outcome differences between RR and LR. Factors associated with increased risk for conversion were male gender, severe cardiac disease and BMI > 30. Conversion was associated with higher rates of major complications (20 out of 95 (21.2%) vs 135 out of 1189 (11.4%) p = 0.005), reoperations (13 out of 95 (13.7%) vs 93 out of 1189 (7.1%) p = 0.020), and longer hospital stay (median 8 days vs 6 days, p = 0.001). CONCLUSION Conversion rate was lower with robotic assisted rectal resections compared with conventional laparoscopy. Conversions were associated with higher rates of postoperative complications.

中文翻译：

---

与传统腹腔镜相比，机器人辅助直肠切除术的转化率较低；一项全国性队列研究。

背景从腹腔镜转为开放通路结直肠手术与较差的术后结果相关。本研究的目的是评估标准腹腔镜直肠切除术 (LR) 和机器人腹腔镜直肠切除术 (RR) 后的转化率和结果。方法 一项为期 5 年的全国队列研究利用前瞻性记录的直肠癌大部腹腔镜切除术患者的数据。数据来自挪威胃肠外科登记处和挪威结直肠癌登记处。主要终点是转化率。次要终点是 30 天内的术后并发症和组织病理学结果。卡方检验、双边 T 检验和 Mann-Whitney U 检验用于单变量分析。单变量和多变量逻辑回归分析均用于分析不同预测因子和结果之间的关系，并进行倾向评分匹配以解决潜在的治疗分配偏倚。结果共纳入1284例患者，其中375例接受RR，909例接受LR。RR 的转化率为 8 / 375 (2.1%)，而 LR 的转化率为 87 / 909 (9.6%) (p < 0.001)。与 LR 相比，RR 与转换风险降低相关（aOR 0.22，95% CI 0.10-0.46）。RR 和 LR 之间没有其他结果差异。与转换风险增加相关的因素是男性、严重心脏病和 BMI > 30。转换与较高的主要并发症发生率相关（95 人中有 20 人（21.2%）对 1189 人中有 135 人（11.4%）p = 0.005） ，再手术（95 例中的 13 例（13. 7%）与 1189 人中的 93 人（7.1%）p = 0.020）和更长的住院时间（中位数 8 天 vs 6 天，p = 0.001）。结论 与传统腹腔镜相比，机器人辅助直肠切除术的转化率较低。转换与较高的术后并发症发生率相关。