Potential urinary function benefits of initial robotic surgery for rectal cancer in the introductory phase

Abstract

We aimed to evaluate the advantages and disadvantages of initial robotic surgery for rectal cancer in the introduction phase. This study retrospectively evaluated patients who underwent initial robotic surgery (n = 36) vs. patients who underwent conventional laparoscopic surgery (n = 95) for rectal cancer. We compared the clinical and pathological characteristics of patients using a propensity score analysis and clarified short-term outcomes, urinary function, and sexual function at the time of robotic surgery introduction. The mean surgical duration was longer in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (288.4 vs. 245.2 min, respectively; p = 0.051). With lateral pelvic lymph node dissection, no significant difference was observed in surgical duration (508.0 min for robot-assisted laparoscopy vs. 480.4 min for conventional laparoscopy; p = 0.595). The length of postoperative hospital stay was significantly shorter in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (15 days vs. 13.0 days, respectively; p = 0.026). Conversion to open surgery was not necessary in either group. The International Prostate Symptom Score was significantly lower in the robot-assisted laparoscopy group compared with the conventional laparoscopy group. Moderate-to-severe symptoms were more frequently observed in the conventional laparoscopy group compared with the robot-assisted laparoscopy group (p = 0.051). Robotic surgery is safe and could improve functional disorder after rectal cancer surgery in the introduction phase. This may depend on the surgeon’s experience in performing robotic surgery and strictly confined criteria in Japan.

Transanal total mesorectal excision and transabdominal robotic surgery for rectal cancer: A retrospective study

“…Robotic transabdominal surgery is expected to overcome some of the limitations of laparoscopic surgery for rectal cancer [ 16 , 17 ]. Several non-randomized studies have suggested that robotic surgery may improve patients’ quality of life by preserving urinary and sexual function [ 24 , [28] , [29] , [30] ]. Additionally, chemoradiotherapy is not widely used in Japan.…”

“…Reports from Japan show an overall survival improvement with LPLND [ 31 ], and recent reports have shown a benefit with LPLND after chemoradiotherapy [ 32 ]. Although LPLND is technically difficult in areas close to large vessels and nerves in the narrow and complex pelvic region, robotic surgery is expected to improve the quality and technical difficulty of LPLND [ 24 , 33 , 34 ]. Moreover, robotic surgery allows many experienced surgeons to more easily approach the pelvic floor.…”

“…The TaTME approach was performed below the fascia, allowing optimal visualization and removal of the endopelvic fascia close to the distal tumor. Additionally, robotic surgery improves identification and preservation of small anatomical structures and facilitates precise TME and LPLND [ 24 ].

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“…We used the tumor-node-metastasis classification, and the adequacy of the resection margins was evaluated using the radial margin (RM) rate [ 25 ]. Residual urine volume was measured as previously described [ 24 ].…”

“…The operating team was organized for a one-team TaTME procedure after the robotic surgery was complete. Robotic surgery was performed as previously described [ 24 ].…”