Short and Long-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Case-Matched Retrospective Study (original) (raw)
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Surgical Endoscopy, 2013
Background Long-term data from the CLASICC study demonstrated the oncologic equivalence of laparoscopic and open rectal cancer surgery despite an increased circumferential resection margin involvement in the laparoscopic group in the initial report. Moreover, laparoscopic total mesorectal excision (TME) may be associated with increased rates of male sexual dysfunction compared to conventional open TME. Robotic surgery could potentially obtain better results than laparoscopy. The aim of this study was to compare the clinical and functional outcomes of robotic and laparoscopic surgery in a single-center experience. Methods This study was based on 100 patients who underwent minimally invasive anterior rectal resection with TME. Fifty consecutive robotic rectal anterior resections with TME (R-TME) were compared to the first 50 consecutive laparoscopic rectal resections with TME (L-TME). Results Median operative time was 270 min in R-TME and 275 min in L-TME. No conversions occurred in the R-TME group whereas six conversions occurred in the L-TME group. The mean number of harvested lymph nodes was 16.5 ± 7.1 for R-TME and 13.8 ± 6.7 for L-TME. The circumferential margin (CRM) was\2 mm in six L-TME patients, whereas no one in R-TME group had a CRM \2 mm. The International Prostate Symptom Score (IPSS) scores were significantly increased 1 month after surgery in both the L-TME and R-TME groups, but they normalized 1 year after surgery. Erectile function worsened significantly 1 month after surgery in both the groups but it was restored completely 1 year after surgery in the R-TME group and partially in the L-TME group. Conclusions Robotic TME is oncologically safe and adequate for rectal cancer treatment, showing better results than laparoscopic TME in terms of CRM, conversions, and hospital length of stay. Better recovery in voiding and sexual function is achieved with the robotic technique.
Comparing outcomes of robotic versus open mesorectal excision for rectal cancer
BJS Open, 2021
Background The outcomes of robot-assisted mesorectal excision for rectal cancer, compared with open resection, have not been fully characterized. Methods A retrospective analysis of pathologic, short-term, and long-term outcomes in patients with rectal adenocarcinoma who underwent total or tumour-specific mesorectal excision at a high-volume cancer centre between 2008 and 2017 was conducted. Outcomes after robotic and open surgery were compared on an intention-to-treat basis. Results Out of 1048 resections performed, 1018 patients were reviewed, with 638 who underwent robotic surgery and 380 open surgery. Robotic surgery was converted to the open approach in 17 (2.7 per cent) patients. Patients who underwent robotic surgery were younger (median 54 (range 22–91) years versus median 58 (range 18–97) years; P < 0.001), had higher tumours (median 80 (range 0–150) mm from the anal verge versus median 70 (0–150) mm; P = 0.001), and were less likely to have received neoadjuvant therapy ...
Robotic Surgery: Research and Reviews, 2014
Laparoscopic total mesorectal excision (TME) is the standard operation for minimal access surgical treatment for rectal cancers. The superiority of the different laparoscopic modalities used to perform TME remains controversial. This study aims to compare the short-term outcomes between robotic TME (R-TME) and the standard laparoscopic TME (ST-TME). Methods: A retrospective review of all patients (n=42) diagnosed with mid/lower rectal carcinoma who underwent R-TME and ST-TME from October 2004 to November 2011 was performed. Patient demographics, perioperative outcomes, and histopathological findings were analyzed. Results: There were 23 patients treated with R-TME. Patient demographics were comparable between both groups. The median operating time was 242 (191-377) minutes in ST-TME and 395 (289-771) minutes in R-TME (P,0.001). ST-TME was associated with a higher conversion rate, at 21.0%, compared to the 4.3% in R-TME (P=0.158). Both groups had a median duration of intravenous analgesia of 2 days (P=0.602), and a median length of hospital stay of 6 (ST-TME) and 7 days (R-TME) (P=0.202). Morbidity rates were 31.6% and 21.7% in the ST-TME and R-TME groups, respectively (P=0.504). The median number of lymph nodes harvested was the same in each group, at 14 (P=0.323). Completeness of TME and margin positivity were similar for both groups. Conclusion: R-TME is safe and feasible, with similar postoperative and surrogate oncological outcomes when compared to ST-TME. While associated with a lower conversion rate, the longer operating time reflects the steep learning curve required to master the technique.
Introduction: Minimally invasive surgery for rectal cancer (RC) is now widely performed via the laparoscopic approach, but robotic-assisted surgery may overcome some limitations of laparoscopy in RC treatment. We compared the rate of positive circumferential margins between robotic, laparoscopic and open total mesorectal excision (TME) for RC in our institution. Methods: Mid and low rectal adenocarcinoma patients consecutively submitted to robotic surgery were compared to laparoscopic and open approach. From our prospective database, 59 patients underwent robotic-assisted rectal surgery from 2012 to 2015 (RTME group) were compared to our historical control group comprising 200 open TME (OTME group) and 41 laparoscopic TME (LTME group) approaches from July 2008 to February 2012. Primary endpoint was to compare the rate of involved circumferential resection margins (CRM) and the mean CRM between the three groups. Secondary endpoint was to compare the mean number of resected lymph nodes between the three groups. Results: CRM involvement was demonstrated in 20 patients (15.5%) in OTME, 4 (16%) in LTME and 9 (16.4%) in the RTME (p ¼ 0.988). The mean CRM in OTME, LTME and RTME were respectively 0.6 cm (0e2.7), 0.7 cm (0e2.0) and 0.6 cm (0e2.0) (p ¼ 0.960). Overall mean LN harvest was 14 (0e56); 16 (0e52) in OTME, 13 (1e56) in LTME and 10 (0e45) in RTME (p ¼ 0.156). Conclusion: Our results suggest that robotic TME has the same oncological short-term results when compared to the open and laparoscopic technique, and it could be safely offered for the treatment of mid and low rectal cancer.
Indian Journal of Surgical Oncology
Emerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) ...
Update on Robotic Total Mesorectal Excision for Rectal Cancer
Journal of Personalized Medicine
The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one o...
Frontiers in Oncology, 2014
The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.
Ejso, 2014
Background: Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce. Methods: The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared. Results: There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P ¼ 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P ¼ 0.024). Conclusion: RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
Annals of Surgical Oncology, 2009
Background. The aim of this study is to compare the short-term results between robotic-assisted low anterior resection (R-LAR), using the da Vinci Ò Surgical System, and standard laparoscopic low anterior resection (L-LAR) in rectal cancer patients. Methods. 113 patients were assigned to receive either R-LAR (n = 56) or L-LAR (n = 57) between April 2006 and September 2007. Patient characteristics, perioperative clinical results, complications, and pathologic details were compared between the groups. Moreover, macroscopic grading of the specimen was evaluated. Results. Patient characteristics were not significantly different between the groups. The mean operation time was 190.1 ± 45.0 min in the R-LAR group and 191.1 ± 65.3 min in the L-LAR group (P = 0.924). The conversion rate was 0.0% in the R-LAR groups and 10.5% in the L-LAR group (P = 0.013). The serious complication rate was 5.4% in the R-LAR group and 19.3% in the L-LAR group (P = 0.025). The specimen quality was acceptable in both groups. However, the mesorectal grade was complete (n = 52) and nearly complete (n = 4) in the R-LAR group and complete (n = 43), nearly complete (n = 12), and incomplete (n = 2) in the L-LAR group (P = 0.033). Conclusion. R-LAR was performed safely and effectively, using the da Vinci Ò Surgical System. The use of the system resulted in acceptable perioperative outcomes compared to L-LAR. Recently, laparoscopic colorectal resection has been popularized because it results in decreased postoperative pain, shorter length of hospitalization, and earlier return to normal functioning, and increasing demand for laparoscopic surgery from patients. 1-3 However, rectal cancer surgery is a more technically demanding procedure than colon cancer surgery because it is performed in the narrow pelvic cavity. Thus, the surgeon needs highly technical skills for the laparoscopic rectal resection. Meanwhile, the da Vinci Ò Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was developed to overcome the disadvantages of conventional laparoscopic surgery such as an assistant-dependent unstable camera platform, two-dimensional view, limited dexterity of instruments inside the patient, and fixed instrument tips. 4,5 Moreover, the robotic system provides excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. These advantages of the robotic system are even more beneficial when the operation field is narrow such as in prostatectomy. Thus, the robotic system's applications have expanded since it was first used in urology in June 2006. 6 We thought that the robotic system would have the same beneficial effect when used for rectal dissection such as prostatectomy in the urology area. These two kinds of surgeries have the same narrow operation field. Therefore, we have used the robotic system for rectal cancer surgery since 2006. 7 Robotic colorectal surgery was first performed in 2001. 8 However, experience with robotic rectal cancer surgery has been limited worldwide. Moreover, few previous studies have assessed its use for rectal cancer surgery compared with conventional laparoscopic surgery. Therefore, this study was designed to evaluate the difference of the short-term outcome after robotic or conventional
Background: The aim of this study was to compare perioperative and long-term oncological outcomes between laparoscopic sphincter-preserving total mesorectal excision in female patients (F-Lap-TME) and robotic sphincter-preserving total mesorectal excision in male patients (M-Rob-TME) with mid-low rectal cancer (RC). Methods: A retrospective analysis of a prospectively maintained database was performed. 170 cases (F-Lap-TME: 60 patients; M-Rob-TME: 110 patients) were performed by a single surgeon (January 2011 - January 2020). Results: Clinical characteristics did not differ significantly between the two groups. Operating time was longer in M-Rob-TME than in F-Lap-TME group (185.3±28.4 vs 124.5±35.8 minutes, p<0.001). There was no conversion to open surgery in both groups. Quality of mesorectum was complete/near-complete in 58 (96.7%) and 107 (97.3%) patients of F-Lap-TME and M-Rob-TME (p=0.508), respectively. Circumferential radial margin involvement was observed in 2 (3.3%) and ...