Open versus minimally invasive surgery for rectal cancer: a single-center cohort study on 237 consecutive patients

Quero, Giuseppe; Rosa, Fausto; Ricci, Riccardo; Fiorillo, Claudio; Giustiniani, Maria Cristina; Cina, Caterina; Menghi, Roberta; Doglietto, Giovanni Battista; Alfieri, Sergio

doi:10.1007/s13304-019-00642-3

Cited by 12 publications

(30 citation statements)

References 45 publications

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“…The introduction of robotic surgery was associated with an initial increase in costs compared with laparoscopy. As experience with the robotic system improves, LOS should decrease and fewer complications will be experienced; this will reduce these costs over time. In this study, the learning curve for robotic surgical techniques and implementation of ERAS management were intentionally avoided.…”

Section: Discussionmentioning

confidence: 99%

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Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

et al. 2020

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Background: Enhanced recovery after surgery (ERAS) pathways are beneficial in proctocolectomy, but their impact on robotic low rectal proctectomy is not fully investigated. This study assessed the impact of an ERAS pathway on the outcomes and cost of robotic (RTME) versus laparoscopic (LTME) total mesorectal excision.Methods: A retrospective review was performed of patients with rectal cancer in a single French tertiary centre for three yearly periods: 2011, LTME; 2015, RTME; and 2018, RTME with ERAS. Patient characteristics, operative and postoperative data, and costs were compared among the groups.Results: A total of 220 consecutive proctectomies were analysed (71 LTME, 58 RTME and 91 RTME with ERAS). A prevalence of lower and locally advanced tumours was observed with RTME. The median duration of surgery increased with the introduction of RTME, but became shorter than that for LTME with greater robotic experience (226, 233 and 180 min for 2011, 2015 and 2018 respectively; P < 0⋅001). The median duration of hospital stay decreased significantly for RTME with ERAS (11, 10 and 8 days respectively; P = 0⋅011), as did the overall morbidity rate (39, 38 and 16 per cent; P = 0⋅002). Pathology results, conversion and defunctioning stoma rates remained stable. RTME alone increased the total cost by €2348 compared with LTME. The introduction of ERAS and improved robotic experience decreased costs by €1960, compared with RTME performed in 2015 without ERAS implementation. In patients with no co-morbidity, costs decreased by €596 for RTME with ERAS versus LTME alone. Conclusion: ERAS is associated with cost reductions in patients undergoing robotic proctectomy.

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Section: Discussionmentioning

confidence: 99%

“…The cost differences between LTME and RTME have been evaluated in single‐centre studies, which have the advantage of standardized management. A previous Italian study determined that mean(s.d.) costs were significantly higher for robotic (€9812(1974)) than for laparoscopic (€9045(1893)) surgery ( P = 0·02).…”

Section: Discussionmentioning

confidence: 99%

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

et al. 2020

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“…The probable reason for this may be the less CRM involvement in RS patients. Ghezzi et al also demonstrated that their RS group had a relatively low cumulative local recurrence rate [19]; conversely, several studies showed no differences among these groups, but all of them had enrolled few patients or had shorter follow-up periods [31][32][33][34].…”

Section: Discussionmentioning

confidence: 98%

“…Recent literatures have revealed that less estimated blood loss, faster recovery time, and shorter length of postoperative stay were observed in RS compared with open surgery [19,34,35]. Considering the limited place in the pelvic area, RS can provide tridimensional view, tremor filtering, better image resolution, and wider operative plane owing to the improved technique.…”

Section: Discussionmentioning

confidence: 99%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

Chen

Huang

et al. 2020

BMC Surg

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Background: Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation. Methods: This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months. Results: Upon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS. Conclusions: This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

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“…Recent literatures have revealed that less estimated blood loss, faster recovery time, and shorter length of postoperative stay were observed in RS compared with open surgery [19,34,35].…”

Section: Discussionmentioning

confidence: 99%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

CHEN

Huang

et al. 2020

Preprint

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Background Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation.Materials and methods This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months.Results Upon multivariate analysis, histologic grade ( P =0.048), tumor depth ( P =0.003), and pre-operative CCRT ( P =0.038) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P <0.05). Multivariable analyses observed the surgical method ( P =0.037), histologic grade ( P =0.006), and CRM involvement ( P =0.043) were the independent factors of DFS, whereas histologic grade ( P =0.011) and pathologic stage ( P =0.022) were the independent prognostic variables of OS.Conclusions This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

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Open versus minimally invasive surgery for rectal cancer: a single-center cohort study on 237 consecutive patients

Cited by 12 publications

References 45 publications

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

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