Robotic versus laparoscopic surgery for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of short-term outcomes

Abstract

The aim of our study was to compare short-term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid-low RC after NCRT.

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

“…Sixteen studies [10–13,15–19,23–29] reported operative time. In particular, 1 study [28] indicated a shorter operative time with RTME, 3 studies [10,24,26] showed no significant difference between techniques, and the rest of studies suggested that operative time was longer with RTME than LTME.…”

“…[10–13,15–19,23–29] Two studies [10,28] showed that it was shorter for RTME, 1 study [18] reported that it was a little longer for RTME, and the remaining studies indicated no significant difference between techniques. Pooled data analysis showed that there was no significant difference between the techniques [WMD = −0.69, 95% CI (−1.48 to 0.10); P  = .089], with high heterogeneity (I 2  = 81.8%; P  < .001) (Fig.…”

“…[11,13–17,19,24–27,29] All studies found no difference between the 2 techniques except 1 study. [13] Pooled data showed that the number of lymph nodes harvested was not significantly different between the techniques [WMD = 0.49, 95% CI (−0.98 to 1.96); P  = .515]. There was high heterogeneity among studies (I 2  = 64.2%, P  < .001) (Fig.…”

“…[13,16–19,26,28,29] Among which, 6 studies showed that there was no significant difference between the 2 groups, while the rest 2 studies found a longer DRM in RTME. And the pooled data indicated a negative result [WMD = 1.98, 95% CI (−1.25 to 5.22); P  = .229], with high heterogeneity (I 2  = 67.8%; P  = .003) (Fig.…”

“…In addition, patients with less extensive or low stage cancers were eligible for robotic-assisted surgery. The sample size of studies included was small, [10,13,14,24] which might contribute to a wide 95% CI.…”