Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis

Lee, Seon Heui; Kim, Dong Hyun; Lim, Sangwoo

doi:10.1007/s00384-018-3145-0

Cited by 61 publications

(80 citation statements)

References 41 publications

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“…The LS group had longer proximal resection margin; however, no differences were observed regarding distal margin, TME status, and adequacy of lymph node retrieval, which was concordant with previous literatures [19][20][21]. Regarding the number of harvested lymph nodes, a lesser amount was noted in the RS group, of which was the same as that observed by Lee et al [22].…”

Section: Discussionsupporting

confidence: 90%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

CHEN

Huang

et al. 2020

Preprint

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Background Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation.Materials and methods This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months.Results Upon multivariate analysis, histologic grade ( P =0.048), tumor depth ( P =0.003), and pre-operative CCRT ( P =0.038) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P <0.05). Multivariable analyses observed the surgical method ( P =0.037), histologic grade ( P =0.006), and CRM involvement ( P =0.043) were the independent factors of DFS, whereas histologic grade ( P =0.011) and pathologic stage ( P =0.022) were the independent prognostic variables of OS.Conclusions This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

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Section: Discussionsupporting

confidence: 90%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

CHEN

Huang

et al. 2020

Preprint

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“…A reduction in the EBL was reported in a series of metaanalyses published on RRS in comparison to LRS and ORS. This reduction was observed in studies that evaluated RRS versus LRS [9,19,20,23] and those that assessed RRS versus ORS [9]. Shiomi et al [33] reported that in RRS, the EBL was 10.5 mL in obese patients and 10.0 mL in non-obese patients without a significant difference (P=0.83), whereas in LRS, the EBL was 34.0 mL in obese patients and 13.0 mL in non-obese patients with a significant difference (P= 0.02).…”

Section: Estimated Blood Lossmentioning

confidence: 84%

“…A longer operative duration was the most consistent shortterm outcome in the series of meta-analysis and RCTs published on RRS for rectal cancer [8,9,[18][19][20][21][22][23][24], (Table 1). Jayne et al reported [8] that the mean operative duration was 37.5 min longer with RRS than with LRS performed by a surgeon experienced with a median of 91 LRS and 50 RRS cases.…”

Section: Operative Duration and Learning Curvementioning

confidence: 96%

“…In this trial, multi-variate logistic regression analyses revealed significantly higher odds of conversion to open laparotomy for obese patients, male patients, and patients who underwent low anterior resection compared with those who underwent abdominoperineal resection. Furthermore, most systematic reviews [11,[19][20][21][22][23]37] reported a lower conversion rate with RRS than with LRS. However, a quality assessment study by Hoshino et al using the AMSTAR-2 tool [38] indicated that the consequences had critically low-quality evidence.…”

Section: Conversion Ratementioning

confidence: 99%

“…In an RCT with a small sample size, Patriti et al [62] reported the OS, DFS, and recurrence rate between the RRS and LRS, and no differences were observed in all categories. Furthermore, several metaanalysis studies [20,21,63] investigated the long-term oncological outcomes. In summary, RRS did not show any superiority over LRS in terms of oncological advantages, and both RRS and LRS provided favorable outcomes for patients with rectal cancer.…”

Section: Long-term Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature

Katsuno

Hanai

Masumori

et al. 2020

J Anus Rectum Colon

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The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Robotic surgery has the potential to overcome some limitations of laparoscopic surgery, especially in the narrow pelvis, providing a three-dimensional view, articulated instruments, and a stable camera platform. Although meta-analyses and randomized controlled trials have failed to demonstrate the superiority of robotic surgery over laparoscopic surgery with respect to the short-term clinical outcomes, the published findings suggest that robotic surgery may be potentially beneficial for patients who are obese, male, or patients undergoing sphincterpreserving surgery for rectal cancer. The safety and feasibility of robotic surgery for lateral lymph node dissection, the standard procedure for locally advanced lower rectal cancer in Japan, have been demonstrated in some retrospective studies. However, additional prospective, randomized trials are required to determine the actual benefits of robotic surgery to ameliorate the urogenital and oncological outcomes. The cost of this approach is a long-standing principal concern. A literature search showed that the cost of robotic surgery for rectal cancer was 1.3-2.5 times higher per patient than that for the laparoscopic approach. We herein describe our surgical technique using a da Vinci Surgical System (S/Si/Xi) with 10 years of experience in performing robotic surgery. We also review current evidence regarding short-term clinical and longterm oncological outcomes, lateral lymph node dissection, and the cost of the procedure.

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Robotic surgery for colorectal cancer

Ruiz

Escribano

Fernández

et al. 2020

Annals of Gastroent Surgery

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Throughout its more than 20 years of activity, surgical robot systems have been incorporating different improvements that replace the inherent limitations of laparoscopic surgery. Some of these improvements consist of changes in the ergonomics and reproduction of hand movements with articulated instruments. In addition, infrared technology and slimmer arms have been incorporated to facilitate procedures in multiple abdominal quadrants without requiring repositioning. This development in technology has meant that more robotic procedures are performed each year is in general surgery. It has experienced important growth in the colorectal field, where it is shown to be feasible and safe.

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Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis

Cited by 61 publications

References 41 publications

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature

Robotic surgery for colorectal cancer

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