Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta‐analysis of short‐term outcome

Trastulli, Stefano; Farinella, Eriberto; Cirocchi, Roberto; Cavaliere, Davide; Avenia, Nicola; Sciannameo, Francesco; Gullà, N; Noya, Giuseppe; Boselli, Carlo

doi:10.1111/j.1463-1318.2011.02907.x

Cited by 249 publications

(170 citation statements)

References 59 publications

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“…Complete mesocolic excision along with lymphadenopathy has been shown to be associated with better oncologic outcomes [7]. [22,23]. None of the three studies found a statistically significant difference in the number of nodes extracted by the robot as compared to laparoscopic resection.…”

Section: Oncologic Outcomesmentioning

confidence: 70%

A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer

et al. 2015

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The goal of this review was to compare long-term oncologic outcomes of robotic versus laparoscopic resection of colorectal cancer. A literature search was performed using PubMed, EMBASE, Cochrane, and Medline (2002-2014). Search terms: laparoscopic, robotic, rectal, colon, surgery, oncologic, and outcomes. Studies comparing overall and disease free survival of robotic versus laparoscopic surgery for colorectal cancer were included. Meta-analysis was performed using OpenMeta[Analyst] for Windows 8. Five studies were identified reporting on overall survival, disease free survival, lymph node extraction, and distal and circumferential resection margin. Three hundred and seventeen patients underwent robotic resection and 368 underwent laparoscopic resection, with similar demographics. Operative times were longer with robotic resections, with no difference in estimated blood loss (EBL) or length of stay. The disease stage was distributed similarly in both groups. Similar numbers underwent neoadjuvant therapy. Laparoscopic resection was associated with 3.2 mm larger distal resection margins (p=0.04) and 2.2 more lymph nodes removed (p=0.001), but with equivalent circumferential resection margin status. Disease-free and overall survival was equivalent. Robotic and laparoscopic surgery for colorectal cancer offer comparable overall and disease free survival. Laparoscopic surgery offered a slight advantage in operative time, distal margin, and lymph node yield. Larger, prospective trials are needed to confirm the equivalence of these approaches.

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Section: Oncologic Outcomesmentioning

confidence: 70%

A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer

et al. 2015

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“…Indeed, the literature has shown evidence of its merits for rectal resections in the male pelvis as well as mid-and low-rectal tumors. [11][12][13] Whether any of these benefits will outweigh the cost of robotic assisted surgery will be addressed in the RObotic versus LAparoscopic Resection for Rectal cancer (ROLARR) study.…”

Section: Technical Improvementsmentioning

confidence: 99%

Current Concepts in Rectal Cancer

Fleshman

Smallwood

2015

Clinics in Colon and Rectal Surgery

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Since the first recorded surgical resection for rectal cancer in 1826 by Jacques Lisfranc, 1 the management of rectal cancer has evolved remarkably with dramatic improvements in local recurrence and mortality. Surgical resection is the only proven curative treatment of rectal cancer and the important advances in care have involved improvements in surgical techniques. Most of these improvements during this time period resulted from a better understanding of the anatomy and pathology of rectal cancer. It is important to be familiar with these important advances in rectal cancer treatment to fully understand the current methods of treatment.Historical Overview: From Miles' Abdominoperineal Resection to Today's Sphincter-Preserving Techniques Rectal Resections before MilesGiovanni Morgagni in the early 18th century was the first to propose rectal resection as a treatment for cancer. 1 However, it took over a century before the first successful rectal resection was performed. Over the years, there have been constant changes in the approach used by surgeons to perform a rectal resection.Rectal resections were first performed using a perineal approach as described in 1826 by Jacques LisFranc. 1,2 He operated in the era before anesthesia and proper antiseptic techniques. Since inadvertent entry into the peritoneal cavity could prove lethal, he chose the perineal approach to evert the rectum and perform a limited resection below the peritoneal reflection. A limited amount of rectum was resected with this approach and no attempt was made to purposely include the mesorectum and draining lymph nodes. 2 Success at that time was based upon whether the patient survived to leave the hospital, and so the risk of local recurrence had very little influence. With the advent of anesthesia and aseptic techniques, operations could now be performed that would provide for a more radical resection. Paul Kraske developed a technique similar to Kocher's technique, where he would incise and detach the left side of the coccyx and sacrum to provide more exposure. This exposure allowed him to resect the rectal cancer with ½ inch margins on either side of the rectum. The proximal bowel would then be pulled down and sutured to the anal sphincter complex. However, this "sacral anus" was difficult for the patient to manage. 1,3 Carl Guessenbauer performed the first transabdominal rectal resection and with closure and colostomy in 1879. This procedure would be later popularized by Henri Hartmann for the purpose of treating diverticulitis. 4 Vincent Czerny is credited with performing the first combined abdominal and perineal approach. This combined approach was never intended but was performed only after an unsuccessful attempt at resection through the perineal approach. 1 In Vogel's review of 1,500 cases performed by 12 of the most prominent 19th century surgeons including Billroth, Kocher, Kraske, and Czerny there was a 21% operative mortality rate with a high (80%) recurrence rate. 3 Surgery certainly had progressed beyond LisFranc's perineal res...

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“…Results from a series of robotic TME suggest that it may allow better preservation of urinary and sexual functions [64]. A meta-analysis of eight non randomised studies of robotic versus laparoscopic rectal excision suggested that the conversion rate to open surgery in the robotic group was significantly lower than that with a laparoscopic surgery [65]. There were no significant differences in operation time, length of hospital stay, time to resume regular diet, postoperative morbidity and mortality, or the oncological accuracy of resection.…”

Section: Management Of Early Rectal Cancer and The Malignant Polypmentioning

confidence: 99%

Paradigm Shift in the Management of Rectal Cancer

Rawat

Evans

2014

Indian J Surg

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Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

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Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta‐analysis of short‐term outcome

Abstract: Robotic surgery for rectal cancer has a lower conversion rate and a similar operative time compared with laparoscopic surgery, with no difference in recovery, oncological and postoperative outcomes.

Cited by 249 publications

References 59 publications

A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer

A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer

Current Concepts in Rectal Cancer

Paradigm Shift in the Management of Rectal Cancer

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