Robotic-Assisted versus Conventional Laparoscopic Approach for Rectal Cancer Surgery, First Egyptian Academic Center Experience, RCT

Abstract

Background Undoubtedly, robotic systems have largely penetrated the surgical field. For any new operative approach to become an accepted alternative to conventional methods, it must be proved safe and result in comparable outcomes. The purpose of this study is to compare the short-term operative as well as oncologic outcomes of robotic-assisted and laparoscopic rectal cancer resections. MethodsThis is a prospective randomized clinical trial conducted on patients with rectal cancer undergoing either robotic-assisted or laparoscopic surgery from April 2015 till February 2017. Patients' demographics, operative parameters, and short-term clinical and oncological outcomes were analyzed. Results Fifty-seven patients underwent permuted block randomization. Of these patients, 28 were assigned to undergo robotic-assisted rectal surgery and 29 to laparoscopic rectal surgery. After exclusion of 12 patients following randomization, 45 patients were included in the analysis. No significant differences exist between both groups in terms of age, gender, BMI, ASA score, clinical stage, and rate of receiving upfront chemoradiation. Estimated blood loss was evidently lower in the robotic than in the laparoscopic group (median: 200 versus 325 ml, p= 0.050). A significantly more distal margin is achieved in the robotic than in the laparoscopic group (median: 2.8 versus 1.8, p< 0.001). Although the circumferential radial margin (CRM) was complete in 18 patients (85.7%) in the robotic group in contrast to 15 patients (62.5%) in the laparoscopic group, it did not differ statistically (p=0.079). The overall postoperative complication rates were similar between the two groups. Conclusion To our knowledge, this is the first prospective randomized trial of robotic rectal surgery in the Middle East and Northern Africa region. Our early experience indicates that robotic rectal surgery is a feasible and safe procedure. It is not inferior to standard laparoscopy in terms of oncologic radicality and surgical complications. Organization number is IORG0003381. IRB number is IRB00004025.

Comparison of pathological outcomes between robotic rectal cancer surgery and laparoscopic rectal cancer surgery: A meta‐analysis based on seven randomized controlled trials

“…In terms of the number of HLNs, when omitting the study from Kim et al, the heterogeneity was greatly declined ( I 2 = 10%, P = .35), and the result was not affected (MD: −0.34, 95% CI, −1.37 to 0.70, P = 53), and the study from Kim et al might be the source of heterogeneity for the data on the number of HLNs. In regard to proximal margin, when omitting the study from Debakey et al, the remaining studies were no heterogeneity ( I 2 = 0, P = .80), and the result was not influenced (MD = 0.76, 95% CI, −0.71 to 2.23, P = .31), and the study from Debakey et al might be the source of heterogeneity for the data on the proximal margin. The source of heterogeneity for the data on the DDM could not be determined using the sensitivity analysis.…”

“…By screening the titles and abstracts, 484 studies were rejected. A full‐text evaluation helped identify seven studies that met the inclusion criteria . The publication year ranged from 2008 to 2018.…”

“…The assessment findings for the study quality and the risk for bias are represented in Figure . Five studies were classified as having a low risk of bias, and two studies were classified as having an unknown risk of bias. Using the GRADE system, the quality of evidence was rated as moderate for five studies and low for the remaining two studies …”

“…Four studies with 689 patients (RRCS, 342; LRCS, 347) described the incidence of incomplete mesorectal excision. Analysis of pooled data from the four trials revealed that the incidence of incomplete mesorectal excision was 22.22% (76/342) in the RRCS group and 25.65% (89/347) in the LRCS group.…”

“…DDM was reported in five RCTs that involved 340 patients (RRCS, 162; LRCS: 178). Analysis of the pooled data from the five studies showed that RRCS was associated with a longer DDM in comparison with LRCS (MD: 0.83 cm, 95% CI, 0.29‐1.37, P = .003).…”