A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer

Abstract

Purpose: The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer. Methods: All patients who underwent resection for rectal cancer from 2016 to 2018 were included. Specimens were divided into 3 sections to analyze the pathology of the lymph nodes (LNs) (n = 137). Results: The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean ± standard deviation: 29.1 ± 8.6 cm vs. 33.8 ± 9.9 cm, P = 0.004) because of a shorter proximal resection margin (21.7 ± 8.7 vs. 26.4 ± 10.6 cm, P = 0.006). The number of recruited LNs (35.8 ± 21.8 vs. 39.6 ± 16.5, P = 0.604) and arterial vessel length (8.84 ± 2.6 cm vs. 8.78 ± 2.4 cm, P = 0.891) did not differ significantly between the 2 surgical approaches. LN metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic LNs were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups. Conclusion: There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of LN metastases, and resection margins.

Can robotic surgery lead the way in the treatment of rectal cancer?

“…Reyes et al [2] conducted a comparative study of surgical and pathologic outcomes in rectal cancer surgery using open and robotic surgery. The study was the first to compare pathologic outcomes of arterial ligation site, ligated vessel length, and resection margin in specimens from robotic and open surgery.…”

“…However, there is still insufficient evidence, including the study by Reyes et al [2], to support the claim that robotic surgery improves oncological outcomes when compared to laparoscopic or open surgery. While the technical advantages of robotic surgery in rectal cancer are increasing, oncological superiority must be established for it to be widely accepted.…”