Clinical Safety and Effectiveness of Robotic-Assisted Surgery in Patients with Rectal Cancer: Real-World Experience over 8 Years of Multiple Institutions with High-Volume Robotic-Assisted Surgery

Abstract

The perioperative and short-term oncological outcomes of robotic-assisted rectal surgery (RRS) are unclear. This retrospective observational study enrolled patients with rectal adenocarcinoma undergoing RRS from three high-volume institutions in Taiwan. Of the 605 enrolled patients, 301 (49.75%), 176 (29.09%), and 116 (19.17%) had lower, middle, and upper rectal cancers, respectively. Low anterior resection (377, 62.31%) was the most frequent surgical procedure. Intraoperative blood transfusion was performed in 10 patients (2%). The surgery was converted to an open one for one patient (0.2%), and ten (1.7%) patients underwent reoperation. The overall complication rate was 14.5%, including 3% from anastomosis leakage. No deaths occurred during surgery and within 30 days postoperatively. The positive rates of distal resection margin and circumferential resection margin were observed in 21 (3.5%) and 30 (5.0%) patients, respectively. The 5-year overall and disease-free survival rates for patients with stage I–III rectal cancer were 91.1% and 86.3%, respectively. This is the first multi-institutional study in Taiwan with 605 patients from three high-volume hospitals. The overall surgical and oncological outcomes were equivalent or superior to those estimated in other studies. Hence, RRS is an effective and safe technique for rectal resection in high-volume hospitals.

Comparison of short‐term outcomes between robot‐assisted and laparoscopic rectal surgery for rectal cancer: A propensity score‐matched analysis using the Japanese Nationwide diagnosis procedure combination database

“…Although none of the differences were significant, robot‐assisted surgery tended to show a longer hospital stay than laparoscopic surgery, possibly due to the lower percentage of educational hospitals used for robot‐assisted surgery (46.5% vs. 53.5%). Huang et al 27 reported on the postoperative results of robot‐assisted surgery for rectal cancer at three high‐volume centers in Taiwan. The complication rate was 14.4%, which was lower than previously reported.…”

Robotic Total Mesorectal Excision for Low Rectal Cancer: A Narrative Review and Description of the Technique

“…However, they reported a significantly lower distant recurrence rate in the robotic arm for patients with T3/T4 tumors (44.8% vs. 9.8), arguing a potential benefit of robotic resections for this subset of patients [52]. Huang et al, in multi-institutional retrospective work, documented a 5-year overall and disease-free survival of 91.1% and 86.3% for 605 patients with stages I-III rectal cancer who underwent robotic TME [53].…”

Determining the optimal distal resection margin in rectal cancer patients by imaging of large pathological sections: An experimental study

“…[7] However, the prognosis was not significantly improved in patients with ultralow rectal cancer compared to patients with middle and upper rectal cancers. [8] Abdominoperineal combined resection was once a surgical procedure for the treatment of ultralow rectal cancer, but it seriously affects the quality of life of patients. [9] With the development of preoperative neoadjuvant radiotherapy and chemotherapy, the technology of laparoscopic surgery continues to improve, and with the evolution of surgical instruments, [10] the success rate of sphincter-sparing surgery (SSS) for ultralow rectal cancer has increased.…”

“…[7] However, the prognosis was not significantly improved in patients with ultralow rectal cancer compared to patients with middle and upper rectal cancers. [8]…”