Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy

Chen, Weiping; Li, Qiken; Qiu, Pengnian; Jiang, Lai; Fu, Zhixuan; Fan, Yong; Li, Dechuan; Liu, Peng; Tang, Lilong

doi:10.4103/0973-1482.200600

Cited by 6 publications

(4 citation statements)

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“…LTME has risen to become the gold standard for rectal cancer suitable for surgical resection[ 7 ]. Many trials including the COLOR II trial established that it gave similar oncological outcomes compared to an open approach[ 8 , 9 ] and further studies showed it resulted in shorter length of stay, less pain and quicker resumption of normal diet[ 10 , 11 ]. The main reason behind these proven advantages of the laparoscopic TME is the reduced surgical trauma and tissue handling compared to open TME.…”

Section: Discussionmentioning

confidence: 99%

“…Total mesorectal excision (TME) performed either by open or laparoscopic technique is an accepted gold standard treatment of rectal cancer worldwide. Laparoscopic TME (LTME) has apparent advantages and considered a preferred mode of surgery due to less tissue trauma[ 5 - 11 ]. Due to precision in dissection, stable base unit and better visualization in difficult areas like lower pelvis, the robotic TME (RTME) is also considered a possible alternative to LTME[ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Jones

Qassem

Sains

et al. 2018

WJGO

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AIMTo compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).METHODSStandard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).RESULTSOne RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.CONCLUSIONRTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Jones

Qassem

Sains

et al. 2018

WJGO

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“…With advancements in surgical technology, particularly in the fields of laparoscopy and robotics, and trends towards decreasing invasiveness, a robotic mini-mally invasive approach to this highly morbid surgery could be advantageous. Rectal cancer afflicts more than 50 persons per 100,000 and accounts for more than 80,000 deaths per year in Europe [2,3]. Multiple clinical studies have examined outcomes following laparoscopic vs open resection of rectal cancer, the majority demonstrating similar oncological outcomes and improved perioperative outcomes [2][3][4][5][6] ies have examined outcomes following robotic approach to rectal cancer excision.…”

Section: Introductionmentioning

confidence: 99%

“…Rectal cancer afflicts more than 50 persons per 100,000 and accounts for more than 80,000 deaths per year in Europe [2,3]. Multiple clinical studies have examined outcomes following laparoscopic vs open resection of rectal cancer, the majority demonstrating similar oncological outcomes and improved perioperative outcomes [2][3][4][5][6] ies have examined outcomes following robotic approach to rectal cancer excision. Prostate cancer is the most common form of cancer in males and the second leading cause of cancer related death.…”

Section: Introductionmentioning

confidence: 99%

Robotic pelvic exenteration and extended pelvic resections for locally advanced or synchronous rectal and urological malignancy

et al. 2021

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Purpose: To describe the surgical technique and examine the feasibility and outcomes following robotic pelvic exenteration and extended pelvic resection for rectal and/or urological malignancy. Materials and Methods: We present a case series of seven patients with locally advanced or synchronous urological and/or rectal malignancy who underwent robotic total or posterior pelvic exenteration between 2012-2016. Results: In total, we included seven patients undergoing pelvic exenteration or extended pelvic resection. The mean operative time was 485±157 minutes and median length of stay was 9 days (6-34 days). There was only one Clavien-Dindo complication grade 3 which was a vesicourethral anastomotic leak requiring rigid cystoscopy and bilateral ureteric catheter insertion. Eightyfive percent of patients had clear colorectal margins with a median margin of 3.5 mm (0.7-8.0 mm) while all urological margins were clear. Six out of seven patients had complete (grade 3) total mesorectal excision. Three patients experienced recurrence at a median of 22 months (21-24 months) post-operatively. Of the three recurrences, one was systemic only whilst two were both local and systemic. One patient died from complications of dual rectal and prostate cancer 31 months after the surgery. Conclusions: We report a large series examining robotic pelvic exenteration or extended pelvic resection and describe the surgical technique involved. The robotic approach to pelvic exenteration is highly feasible and demonstrates acceptable peri-operative and oncological outcomes. It has the potential to benefit patients undergoing this highly complex and morbid procedure.

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Laparoscopy is non‐inferior to open surgery for rectal cancer: A systematic review and meta‐analysis

Ma,

Yu,

Zhu

et al. 2024

Cancer Medicine

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BackgroundLaparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery.AimsWe started this largest‐to‐date meta‐analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery.Materials & MethodsBoth randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups.ResultsTwenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3‐year and 5‐year local recurrence, disease‐free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches.ConclusionLaparoscopy is non‐inferior to open surgery for rectal cancer with respect to oncological outcomes and long‐term survival. Moreover, laparoscopic surgery provides short‐term advantages, including faster recovery and less complications.

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Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy

Abstract: We concluded that laparoscopic TME following nCRT is feasible and safe for patients with mid-low rectal cancer. Furthermore, tumor distance to anal verge and age are two important determinants of both operative times and postoperative morbidity, regardless of surgical option.

Cited by 6 publications

References 0 publications

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial

Robotic pelvic exenteration and extended pelvic resections for locally advanced or synchronous rectal and urological malignancy

Laparoscopy is non‐inferior to open surgery for rectal cancer: A systematic review and meta‐analysis

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