Robotic Versus Laparoscopic Total Mesorectal Excision for Sphincter-Saving Surgery: Results of a Single-Center Series of 400 Consecutive Patients and Perspectives

Rouanet, Philippe; Bertrand, Martin; Jarlier, Marta; Mourrégot, A.; Traoré, Drissa; Taoum, Christophe; Forges, Hélène de; Colombo, Pierre‐Emmanuel

doi:10.1245/s10434-018-6738-5

Cited by 68 publications

(62 citation statements)

References 31 publications

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“…The surgical procedures were standardized for all patients and done by the same team under a single senior surgeon, with no differences between groups. The RTME technique was as described previously. ERAS management was completed according to the most recent guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…The national LOS for the different surgical approaches, as well as the additional instrumentation costs, were extracted from the French National Cost Studies. To limit sample size bias, the conversion rates reported in a large 400‐patient study that had been conducted in the authors' hospital were used: 9·5 per cent for laparoscopy and 2 per cent for robot‐assisted surgical approaches.…”

Section: Methodsmentioning

confidence: 99%

“…Robotic total mesorectal excision (RTME) in patients with rectal cancer can provide several advantages compared with laparoscopic total mesorectal excision (LTME), including the use of a stable three‐dimensional camera, wristed instrumentation, and ease of dissection in narrow spaces such as in male and fatty pelvis. Nevertheless, evidence is sparse and robust prospective studies are needed to demonstrate the benefits of RTME.…”

Section: Introductionmentioning

confidence: 99%

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Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

et al. 2020

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Background: Enhanced recovery after surgery (ERAS) pathways are beneficial in proctocolectomy, but their impact on robotic low rectal proctectomy is not fully investigated. This study assessed the impact of an ERAS pathway on the outcomes and cost of robotic (RTME) versus laparoscopic (LTME) total mesorectal excision.Methods: A retrospective review was performed of patients with rectal cancer in a single French tertiary centre for three yearly periods: 2011, LTME; 2015, RTME; and 2018, RTME with ERAS. Patient characteristics, operative and postoperative data, and costs were compared among the groups.Results: A total of 220 consecutive proctectomies were analysed (71 LTME, 58 RTME and 91 RTME with ERAS). A prevalence of lower and locally advanced tumours was observed with RTME. The median duration of surgery increased with the introduction of RTME, but became shorter than that for LTME with greater robotic experience (226, 233 and 180 min for 2011, 2015 and 2018 respectively; P < 0⋅001). The median duration of hospital stay decreased significantly for RTME with ERAS (11, 10 and 8 days respectively; P = 0⋅011), as did the overall morbidity rate (39, 38 and 16 per cent; P = 0⋅002). Pathology results, conversion and defunctioning stoma rates remained stable. RTME alone increased the total cost by €2348 compared with LTME. The introduction of ERAS and improved robotic experience decreased costs by €1960, compared with RTME performed in 2015 without ERAS implementation. In patients with no co-morbidity, costs decreased by €596 for RTME with ERAS versus LTME alone. Conclusion: ERAS is associated with cost reductions in patients undergoing robotic proctectomy.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

et al. 2020

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“…Furthermore, Jayne et al assessed female sexual functioning with the Female Sexual Function Index (FSFI, higher scores indicating better function) and found no significant difference between scores for the laparoscopic and the RAS group at 6-month postoperatively (laparoscopy minus RAS: 1.231; CI − 3.54, 6.00; p = 0.60) [11]. Rouanet et al did not find significant differences for the FSFI or IIEF between RAS and laparoscopy but provided graphical results which were not feasible for pooling [35].…”

Section: Urinary Retentionmentioning

confidence: 99%

“…The heterogeneity was low (I 2 = 0%). In addition, Rouanet et al also found no differences between the two groups [35]. Kim et al reported no differences between laparoscopy and RAS for quality of life at 3 weeks, 3 months and 12 months [34].…”

Section: Quality Of Lifementioning

confidence: 99%

Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis

et al. 2020

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Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision, survival has improved substantially. Consequently, more patients have to deal with side effects of treatment. The most recently introduced surgical technique is robotic-assisted surgery (RAS) which seems equally effective in terms of oncological control compared to laparoscopy. However, RAS enables further advantages which maximize the precision of surgery, thus providing better functional outcomes such as sexual function or contience without compromising oncological results. This review was done according to the PRISMA and AMSTAR-II guidelines and registered with PROSPERO (CRD42018104519). The search was planned with PICO criteria and conducted on Medline, Web of Science and CENTRAL. All screening steps were performed by two independent reviewers. Inclusion criteria were original, comparative studies for laparoscopy vs. RAS for rectal cancer and reporting of functional outcomes. Quality was assessed with the Newcastle-Ottawa scale. The search retrieved 9703 hits, of which 51 studies with 24,319 patients were included. There was a lower rate of urinary retention (non-RCTs: Odds ratio (OR) [95% Confidence Interval (CI)] 0.

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Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

Crippa

Grass

Achilli

et al. 2020

British Journal of Surgery

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Background The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery. Methods A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m2 or more) was performed. Results A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non‐obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71). Conclusion Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non‐obese patients.

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Robotic Versus Laparoscopic Total Mesorectal Excision for Sphincter-Saving Surgery: Results of a Single-Center Series of 400 Consecutive Patients and Perspectives

Abstract: R-TME is less likely to be converted to open surgery than L-TME; operative time and curative pathologic criteria are equivalent. Future prospective trial should compare standardized procedures performed by experienced surgeons for subgroups of high-risk patients.

Cited by 68 publications

References 31 publications

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis

Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

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