Local recurrence of robot-assisted total mesorectal excision: a multicentre cohort study evaluating the initial cases

Abstract

Purpose Evidence regarding local recurrence rates in the initial cases after implementation of robot-assisted total mesorectal excision is limited. This study aims to describe local recurrence rates in four large Dutch centres during their initial cases. Methods Four large Dutch centres started with the implementation of robot-assisted total mesorectal excision in respectively 2011, 2012, 2015, and 2016. Patients who underwent robot-assisted total mesorectal excision with curative intent in an elective setting for rectal carcinoma defined according to the sigmoid take-off were included. Overall survival, disease-free survival, systemic recurrence, and local recurrence were assessed at 3 years postoperatively. Subsequently, outcomes between the initial 10 cases, cases 11–40, and the subsequent cases per surgeon were compared using Cox regression analysis. Results In total, 531 patients were included. Median follow-up time was 32 months (IQR: 19–50]. During the initial 10 cases, overall survival was 89.5%, disease-free survival was 73.1%, and local recurrence was 4.9%. During cases 11–40, this was 87.7%, 74.1%, and 6.6% respectively. Multivariable Cox regression did not reveal differences in local recurrence between the different case groups. Conclusion Local recurrence rate during the initial phases of implantation of robot-assisted total mesorectal procedures is low. Implementation of the robot-assisted technique can safely be performed, without additional cases of local recurrence during the initial cases, if performed by surgeons experienced in laparoscopic rectal cancer surgery.

Implementation of totally robotic right hemicolectomy: lessons learned from a prospective cohort

“…Robotics in colorectal surgery was initially reserved for rectal cancer surgery in patients in whom laparoscopy would have shown technical limitations [ 20 – 22 ]. However, with increasing access to the robotic platforms, indications for robotic surgery expanded in colorectal surgery.…”

“…Initial reports from other teams documented a mean operative time of 327.5 min for performing robRHC [ 24 ] and was slightly shorter (285.6 ± 71.5 min) in a cohort of a single experienced surgeon who performed 108 robRHC [ 23 ]. In our cohort of patients, the mean operative time (defined as the skin-to-skin time) was of 200.4 ± 114.9 min, probably because the three consultant surgeons performing robRHC in our centre were already experienced in robotic colorectal surgery and had cumulated a significant number of (low) anterior resections for rectal cancer [ 20 – 22 ]. Therefore, we believe that operative time during robRHC, which is longer than for lapRHC [ 25 ], could be reduced with experience in robotic surgery.…”