Robotic rectal resection: oncologic outcomes

Abstract

Robotic surgery has progressively gained popularity in the treatment of rectal cancer. However, only a few studies on its oncologic effectiveness are currently present, with contrasting results. The purpose of this study is to report a single surgeon’s experience on robotic rectal resection (RRR) for cancer, focusing on the analysis of oncologic outcomes, both in terms of pathological features and long-term results. One-hundred and twenty-two consecutive patients who underwent RRR for rectal cancer from January 2013 to December 2019 were retrospectively enrolled. Patients’ characteristics and perioperative outcomes were collected. The analyzed oncologic outcomes were pathological features [distal (DM), circumferential margin (CRM) status and quality of mesorectal excision (TME)] and long-term outcomes [overall (OS) and disease-free survival (DFS)]. The mean operative time was 275 (± 60.5) minutes. Conversion rate was 6.6%. Complications occurred in 27 cases (22.1%) and reoperation was needed in 2 patients (1.5%). The median follow-up was 30.5 (5.9–86.1) months. None presented DM positivity. CRM positivity was 2.5% (2 cases) while a complete TME was reached in 94.3% of cases (115 patients). Recurrence rate was 5.7% (2 local, 4 distant and 1 local plus distant tumor relapse). OS and DFS were 90.7% and 83%, respectively. At the multivariate analysis, both CRM positivity and near complete/incomplete TME were recognized as negative prognostic factors for OS and DFS. Under appropriate logistic and operative conditions, robotic surgery for rectal cancer proves to be oncologically effective, with adequate pathological results and long-term outcomes. It also offers acceptable peri-operative outcomes, further confirming the safety and feasibility of the technique.

Preliminary evaluation of two-row versus three-row circular staplers for colorectal anastomosis after rectal resection: a single-center retrospective analysis

“…All surgical procedures were performed by two senior surgeons with an extensive experience in colorectal surgery, according to standardized surgical steps as previously reported [18,19]. A mechanical bowel preparation was prescribed and performed two days before surgery in all cases.…”

Robot‐assisted laparoscopic abdominoperineal resection for anal canal cancer associated with Crohn's disease: A case report

“…8 Robotic rectal resection has a low rate of positive circumferential resection margins, a high rate of appropriate total mesorectal excision, and good overall and disease-free survival. 9 Even when focusing on abdominoperineal resection, robotic surgery has demonstrated better short-term outcomes than laparoscopic surgery, suggesting that it could be a useful approach. 10 However, one of the disadvantages of robotic surgery is the high cost associated with its implementation and maintenance.…”

“…A large meta‐analysis by Khajeh et al showed that robotic surgery had better outcomes than the laparoscopic approach in terms of bleeding, the need for reoperation, and complete tumor resection 8 . Robotic rectal resection has a low rate of positive circumferential resection margins, a high rate of appropriate total mesorectal excision, and good overall and disease‐free survival 9 . Even when focusing on abdominoperineal resection, robotic surgery has demonstrated better short‐term outcomes than laparoscopic surgery, suggesting that it could be a useful approach 10 …”

Hyperglycemia is associated with worse 3-year survival in older patients admitted to the intensive care unit after non-cardiac surgery: Post hoc analysis of a randomized trial

“…Only a few studies investigated the association between postoperative hyperglycemia and long-term outcomes. In a retrospective study, 173 patients without diabetes underwent curative gastric cancer surgery and 104 patients were included in the final analysis after propensity score matching; postoperative hyperglycemia (defined as at least one blood glucose ≥ 7.8 mmol/L within 72 h) was associated with worse 5-year overall survival and worse 5-year disease-free survival (21). In the present study, the sample size and the number of end-point events were far larger than in the above one.…”

“…In a retrospective study of 505 patients following peripheral arterial bypass surgery, immediate postoperative hyperglycemia (≥7.8 mmol/L) was associated with an increased risk of long-term amputations (13). In another retrospective study, 104 patients were included in the analysis after propensity score matching; those with postoperative hyperglycemia (≥ 7.8 mmol/L) had worse long-term survival after gastric cancer surgery (21). Whereas a 44-month follow-up of 189 patients enrolled in a randomized trial showed that strict (5-6.7 mmol/L) compared with liberal (6.7-10 mmol/L) glucose management did not change long-term survival and quality of life after coronary bypass surgery (22), but the trial was seriously underpowered.…”