Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence

Liao, Guixiang; Li, Yanbing; Zhao, Zhihong; Li, Xianming; Deng, Haijun; Li, Gang

doi:10.1038/srep26981

Cited by 33 publications

(46 citation statements)

References 51 publications

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“…Several studies have demonstrated that RALS is a safe and feasible approach in various colorectal procedures; however, robust clinical evidence supporting the benefit of robotic‐assisted surgery for rectal cancer remains limited. The results from recent RCTs and meta‐analyses of RALS vs CLS or OS for rectal cancer are summarized in Table . Several recent meta‐analyses have shown a significant difference in the outcomes between RALS and CLS for rectal cancer, including the rates of conversion to OS and positive CRM.…”

Section: Short‐term Outcomesmentioning

confidence: 99%

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Matsuyama

Kinugasa

Nakajima

et al. 2018

Annals of Gastroent Surgery

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Interest in minimally invasive surgery has increased in recent decades. Robotic‐assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual‐console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.

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Section: Short‐term Outcomesmentioning

confidence: 99%

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Matsuyama

Kinugasa

Nakajima

et al. 2018

Annals of Gastroent Surgery

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“…Lee et al [67] showed no differences in operative time between robotic and transanal-TME [67] . Other studies reported less blood loss for robotic TME, compared with the open and laparoscopic approaches [68,69] . Intraoperative complications were found similar for robotic surgery when compared with the open and laparoscopic approaches [26,66] .…”

Section: Intraoperative Outcomesmentioning

confidence: 98%

“…Anastomotic leak rate was not significantly different for robotics compared with open and laparoscopic operations [28,69] . Laparoscopic, transanal, and robotic TME also showed similar leak and reoperation rates [67,70] .…”

Section: Postoperative Outcomesmentioning

confidence: 99%

Robotic total mesorectal excision: state of the art

Sebastián-Tomás¹,

Santarrufina-Martínez²,

Navarro-Martínez³

et al. 2019

MIS

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Minimally-invasive conventional up-to-down laparoscopic approach is a widespread alternative for rectal cancer resection. Its potential benefits towards open surgery have been shown to rely, however, at secondary clinical outcomes, and its oncological non-inferiority compared with the traditional open approach has not been demonstrated yet. In this scenario, robotic-assisted minimally-invasive rectal resection has gained increasing popularity and promising expectancies. This narrative review aims to assemble the most updated evidence available and to discuss the future perspectives and challenges for this emergent surgical tool. The main benefit over conventional laparoscopy appears to be a reduction of conversion rates to open surgery, whereas the oncologic and functional outcomes seem similar than the other alternatives. Increased costs are the main limitation of the widespread of robotic technology. Low quality of the current evidence is remarkable.

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“…A systematic review and metaanalysis of seven studies with 1074 patients compared the safety and efficacy of robot-assisted versus open surgery in rectal cancer. 27 Robotic-assisted surgery was associated with decreased intraoperative blood loss (EBL), shorter length of stay, and shorter time to flatus, but longer operation times. There were no differences in complications, distal resection margin, or disease-free survival between the two groups.…”

Section: Robotic Anastomosis After Right Colectomymentioning

confidence: 99%

Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

Andolfi

Umanskiy

2019

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Robotic technology aims to obviate some of the limitations of conventional laparoscopic surgery, yet the role of robotics in colorectal surgery is still largely undefined and varies with respect to its application in abdominal versus pelvic surgery. Methods: With this review, we aimed to highlight current developments in colorectal robotic surgery. We systematically searched the following databases: PubMed, EMBASE, and Cochrane Library. We critically reviewed the available literature on the use of robotic technology in colon and rectal surgery. Results: Robotic colorectal surgery is oncologically safe and has short-term outcomes comparable to conventional laparoscopy, with potential benefits in rectal surgery. It has a shorter learning curve but increased operative times and costs. It offers potential advantages in the resection of rectal cancer, due to lower conversion rates. There is also a trend toward better outcomes in anastomotic leak rates, circumferential margin positivity, and perseveration of autonomic function. Conclusion: Laparoscopy remains technically challenging and conversion rates are still high. Therefore, most cases of colorectal surgery are still performed open. Robotic surgery aims to overcome the limits of the laparoscopic technique. This new technology has many advantages in terms of articulating instruments, advanced three-dimensional optics, surgeon ergonomics, and improved accessibility to narrow spaces, such as the pelvis. However, further studies are needed to assess long-term results and benefits.The first report on laparoscopic right colectomy was published by Jacobs et al. 1 ; shortly following that Fowler performed the first laparoscopic left colectomy. Since these initial reports, several large studies found that the oncologic outcomes of laparoscopic colectomy were equivalent to open surgery. Despite the growing evidence supporting the use of laparoscopic colectomy for colon cancer, the adoption of this technique was relatively slow due to some limitations: loss of stereoscopic vision and depth perception, paradoxical motion of the instruments, amplified movements, parallel instrumentation, and suboptimal ergonomics. To overcome these shortfalls, the use of hand-assisted laparoscopy was introduced as a bridge between open and laparoscopic surgery. 2,3 Robotic colectomy was first reported in 2002 and since that time adoption of robotic surgery has steadily increased, as evidenced by the number of publications in both medical and lay press. The da Vinci robotic system, the only currently available robotic system in the market approved by the FDA for colorectal surgery, provides several advantages over traditional laparoscopic surgery including a stable camera platform, threedimensional (3D) imaging, improved ergonomics, tremor elimination, ambidextrous capability, motion scaling, and

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Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence

Cited by 33 publications

References 51 publications

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Robotic total mesorectal excision: state of the art

Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

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