A Comparison of Pathologic Outcomes of Open, Laparoscopic, and Robotic Resections for Rectal Cancer Using the ACS-NSQIP Proctectomy-Targeted Database: a Propensity Score Analysis

Garfinkle, Richard; Abou-Khalil, Maria; Bhatnagar, Sahir; Wong-Chong, Nathalie; Azoulay, Laurent; Morin, Nancy; Vasilevsky, Carol‐Ann; Boutros, Marylise

doi:10.1007/s11605-018-3974-8

Cited by 20 publications

(11 citation statements)

References 38 publications

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“…The literature search process identified 1022 studies ( Figure 1 ). After excluding duplicate publications, reviews, meta-analyses, editorials, letters, abstracts and case reports, 72 studies were fully reviewed, and 41 were considered eligible for the meta-analysis [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. The risk of bias according to the authors of the present study was low for 32 studies, moderate for 10 studies ( Figures S1–S4 ).…”

Section: Resultsmentioning

confidence: 99%

Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients

Safiejko

Tarkowski²,

Koselak

et al. 2021

Cancers

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Robotic-assisted surgery is expected to have advantages over standard laparoscopic approach in patients undergoing curative surgery for rectal cancer. PubMed, Cochrane Library, Web of Science, Scopus and Google Scholar were searched from database inception to November 10th, 2021, for both RCTs and observational studies comparing robotic-assisted versus standard laparoscopic surgery for rectal cancer resection. Where possible, data were pooled using random effects meta-analysis. Forty-Two were considered eligible for the meta-analysis. Survival to hospital discharge or 30-day overall survival rate was 99.6% for RG and 98.8% for LG (OR = 2.10; 95% CI: 1.00 to 4.43; p = 0.05). Time to first flatus in the RG group was2.5 ± 1.4 days and was statistically significantly shorter than in LG group (2.9 ± 2.0 days; MD=-0.34; 95%CI: −0.65 to 0.03; p = 0.03). In the case of time to a liquid diet, solid diet and bowel movement, the analysis showed no statistically significant differences (p > 0.05). Length of hospital stay in the RG vs LG group varied and amounted to 8.0 ± 5.3 vs 9.5 ± 10.0 days (MD = −2.01; 95%CI: −2.90 to −1.11; p < 0.001). Overall, 30-days complications in the RG and LG groups were 27.2% and 19.0% (OR = 1.11; 95%CI: 0.80 to 1.55; p = 0.53), respectively. In summary, robotic-assisted techniques provide several advantages over laparoscopic techniques in reducing operative time, significantly lowering conversion of the procedure to open surgery, shortening the duration of hospital stay, lowering the risk of urinary retention, improving survival to hospital discharge or 30-day overall survival rate.

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Section: Resultsmentioning

confidence: 99%

Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients

Safiejko

Tarkowski²,

Koselak

et al. 2021

Cancers

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“…Given that laparoscopic proctectomy failed to reach non-inferiority compared to open proctectomy for pathologic outcomes in rectal cancer, as demonstrated by the ACOSOG Z6051 trial [12], and that robotic proctectomy has not been directly compared to the open approach, ongoing analysis of outcomes for robotic rectal cancer surgery is imperative. Several studies have demonstrated no difference in oncologic outcomes between robotic and laparoscopic proctectomy for rectal cancer, but these did not analyze outcomes by BMI subgroup [9,[13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis

et al. 2022

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Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by previous subgroup analyses. We performed a retrospective review of 2016–2018 National Surgery Quality Improvement Program (NSQIP) data to compare outcomes between patients who underwent robotic versus laparoscopic proctectomy, stratified by Body Mass Index (BMI) subgroups. We also compared outcomes of converted minimally invasive proctectomy to planned open operations. Four thousand four hundred eighteen (69.3%) patients underwent laparoscopic proctectomy, and 1956 (30.7%) patients underwent robotic proctectomy. Robotic proctectomy was associated with a significantly lower conversion rate compared to laparoscopic proctectomy (5.1% vs 12.3%; p = 0.002), and this relationship was maintained on an adjusted model. Obese (BMI > 30) patients were more likely to require conversion in both laparoscopic and robotic groups with the greatest difference in the conversion rate in the obese subgroup. Patients who underwent conversion had higher composite morbidity compared to patients who underwent planned open operations (50.8% vs 41.3%; p < 0.001). And among patients with rectal cancer, robotic proctectomy was associated with a greater incidence of positive radial tumor margins compared to laparoscopic proctectomy (8.0% vs 6.4%; p = 0.039), driven primarily by the obese subgroup. Our study demonstrates that robotic proctectomy is associated with a 7% lower conversion rate compared to laparoscopy and that obese patients are more likely to require conversion than non-obese patients. Among obese patients with rectal cancer, we identified an increased risk of positive radial margins with robotic compared to laparoscopic proctectomy.

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“…In contrast, two retrospective studies noted lower conversion rates by robotic approach: The larger was a single center study with 200 patients per arm (2% vs 10%), the smaller one with 29 vs 37 patients (0% vs 20%)[ 36 , 37 ]. Four larger database studies found the robotic approach to reduce the number of conversions[ 38 - 41 ], which was associated with a reduced length of stay of 8 d and 15 d, respectively.…”

Section: Short Term Outcomes: Operative Characteristicsmentioning

confidence: 99%

Role of minimally invasive surgery for rectal cancer

Melstrom

Kaiser

2020

WJG

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Rectal cancer is one of the most common malignancies worldwide. Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy (total mesorectal excision). This has traditionally been performed transabdominally through an open incision. Over the last thirty years, minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach. There are currently three resective modalities that complement the traditional open operation: (1) Laparoscopic surgery; (2) Robotic surgery; and (3) Transanal total mesorectal excision. In addition, there are several platforms to carry out transluminal local excisions (without lymphadenectomy). Evidence on the various modalities is of mixed to moderate quality. It is unreasonable to expect a randomized comparison of all options in a single trial. This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks, recovery and complications, oncological and functional outcomes.

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A Comparison of Pathologic Outcomes of Open, Laparoscopic, and Robotic Resections for Rectal Cancer Using the ACS-NSQIP Proctectomy-Targeted Database: a Propensity Score Analysis

Cited by 20 publications

References 38 publications

Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients

Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients

Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis

Role of minimally invasive surgery for rectal cancer

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