Robotic-Assisted versus Laparoscopic Surgery for Low Rectal Cancer: Case-Matched Analysis of Short-Term Outcomes

Park, Jun Seok; Choi, Gyu–Seog; Lim, Kyoung Hoon; Jang, You Seok; Jun, Soo Han

doi:10.1245/s10434-010-1162-5

Cited by 215 publications

(204 citation statements)

References 26 publications

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“…Similar findings were presented in other studies, where robotic surgery was shown to have lower or even a zero conversion rate (20)(21)(22). Despite this, other studies found no difference in conversion rates between robotic and laparoscopic surgery (23)(24)(25)(26).…”

Section: Conversion Ratesupporting

confidence: 87%

A review on robotic surgery in rectal cancer

Azman

Kim

2016

Transl. Gastroenterol. Hepatol.

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Robotic surgery has the upper hand when compared to the laparoscopic approach in terms of superior visualisation, flexibility in movement, steadiness and accessibility to confined anatomical spaces.Nevertheless, limitations still exist with regards to cost, reduced tactile sensation, time-consuming setup and a significant learning curve to achieve. Although studies have shown better or at least comparable outcomes between the robotic and laparoscopic approach, the limitations mentioned result in poor penetrance among centres and surgeons. Advancements in robotic surgery technology and attaining the acquired skillset will translate into better clinical outcomes for patients.

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Section: Conversion Ratesupporting

confidence: 87%

A review on robotic surgery in rectal cancer

Azman

Kim

2016

Transl. Gastroenterol. Hepatol.

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“…The studies by Pigazzi et al and J. C. Kim et al noted a similar mean distal margin of 2.9 and 2.7 cm, respectively. [6,9,13,19,20] The superior visualization and precise sharp dissection are the core advantages which the surgeon appreciates by using the robotic system especially in locally advanced cancer patients who have received preoperative chemoradiotherapy. The quality of the rectal cancer surgery can be measured by the evaluation of the mesorectal grade or the harvested lymph node number and autonomic nerve preservation.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer—Indian Study

Somashekhar

Ashwin²,

Rajashekhar

et al. 2013

Indian J Surg

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Rectal cancer is one of the common cancers in India. Surgical management is the mainstay of initial treatment for majority of patients. Minimally invasive surgery has gained acceptance for the surgical treatment of rectal cancer because, compared with laparotomy, it is associated with fewer complications, shorter hospitalization, and faster recovery. The aim of this study is to evaluate the safety, feasibility, technique, and outcomes (postoperative, oncological, and functional) of robotic-assisted rectal surgery in comparison with open surgery in the Indian population. A prospective randomized study was undertaken from August 2011 to December 2012. Fifty patients who presented with rectal carcinoma were randomized to either robotic arm (RA) or open arm (OA) group. Both groups were matched for clinical stage and operation type. Technique and feasibility of roboticassisted surgery in terms of operating time, estimated blood loss, margins status, total number of lymph nodes retrieved, hospital stay, conversion to open procedure, complications, and functional outcomes were analyzed. The mean operative time was significantly longer in the RA than in the OA group (310 vs 246 min, P <0.001) but was significantly reduced in the latter part of the robotic-assisted patients compared with the initial patients. The mean estimated blood loss was significantly less in the RA compared with the OA group (165.14 vs 406.04 ml, P <0.001). None of the patients had margin positivity. The mean distal resection margin was significantly longer in the RA than in the OA group (3.6 vs 2.4 cm, P < 0.001). A total of 100 % of patients in the RA group had complete mesorectal excision while two patients in the OA group had incomplete mesorectal excision. The average number of retrieved lymph nodes was adequate for accurate staging. The number of lymph nodes removed by robotic method is slightly higher than the open method (16.88 vs 15.20) but with no statistical significance. Conversion rate was nil. The mean hospital stay was significantly shorter in the RA group (7.52 vs 13.24 days, P <0.001). Postoperative and functional outcomes were comparable between the two groups. Roboticassisted surgery is an emerging technique in our country. Robotic-assisted rectal cancer surgery is safe with low conversion rates and acceptable morbidity and is oncologically feasible.

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“…When we focus on the major surgical complications such as anastomotic leak or rectovaginal fistula, significant difference was not observed between groups, in accordance with other studies. 9,23 However, ileus, urinary retention, and rectal mucosal prolapse occurred relatively often in laparoscopic group compared to robotic group. Several studies demonstrated that robotic rectal surgery is associated with better voiding function especially in the immediately postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Comparative Study of Short-term Outcomes

Shin

Park

Kim

et al. 2015

J Minim Invasive Surg

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Purpose: Intersphincteric resection (ISR) is a surgical option to preserve the anal sphincter for treatment of low rectal cancer. Laparoscopic ISR has been reported to be technically challenging. The Aim of this study was to assess the short-term outcomes of robotic ISR compared with a laparoscopic approach. Methods:Ninety four consecutive patients who underwent laparoscopic (n=60) or robotic (n=34) ISR with hand-sewn coloanal anastomosis for low rectal cancer from January 2011 to December 2014 were included. Patient demographics, operative data, and histopathologic and postoperative outcomes were analyzed.Results: There were no differences in demographic data including tumor location, which was 2.5±0.7cm from the anal verge in the laparoscopic group and 2.7±0.9 cm in the robotic group. Mean operation time was significantly longer in the robotic group compared with the laparoscopic group (278±65.3 minutes versus 225±66.9, p<0.001). With respect to histopathologic outcomes, patients with circumferential resection margin (CRM) less than 2 mm were observed more frequently in the laparoscopic group than in the robotic group (18.3% versus 5.9%, p=0.050). The rate of postoperative morbidity was lower in the robotic group than in the laparoscopic group (14.7% versus 35.0%, p=0.035). Patients in the robotic group showed a low Clavien-Dindo score more frequently than those in the laparoscopic group (p=0.049). Conclusion:Robotic ISR is a safe and feasible procedure associated with a lower rate of narrow CRM and postoperative morbidity in spite of a longer operation time, compared with the laparoscopic approach. Prospective clinical trials with larger numbers of cases evaluating long-term oncologic and functional outcomes are required.

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Robotic-Assisted versus Laparoscopic Surgery for Low Rectal Cancer: Case-Matched Analysis of Short-Term Outcomes

Abstract: RAP was safe and effective for patients with low rectal cancer. Furthermore, the technical advantages of robot surgical systems may allow a novel approach using hybrid natural orifice surgery.

Cited by 215 publications

References 26 publications

A review on robotic surgery in rectal cancer

A review on robotic surgery in rectal cancer

Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer—Indian Study

Robotic versus Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Comparative Study of Short-term Outcomes

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