Short and Long-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer

Abstract

The true benefits of robotic surgery are controversial, and whether robotic total mesorectal excision (R-TME) can be justified as a standard treatment for rectal cancer patients needs to be clarified. This case-matched study aimed to compare the postoperative complications and short- and long-term outcomes of R-TME and laparoscopic TME (L-TME) for rectal cancer.Among 1029 patients, we identified 278 rectal cancer patients who underwent R-TME. Propensity score matching was used to match this group with 278 patients who underwent L-TME.The mean follow-up period was similar between both groups (L-TME vs R-TME: 52.5 ± 17.1 vs 51.0 ± 13.1 months, P = 0.253), as were patient characteristics. The operation time was significantly longer in the R-TME group than in the L-TME group (361.6 ± 91.9 vs 272.4 ± 83.8 min; P < 0.001), whereas the conversion rate, length of hospital stay, and recovery of pain and bowel motility were similar between both groups. The rates of circumferential resection margin involvement and early complications were similar between both groups (L-TME vs R-TME: 4.7% vs 5.0%, P = 1.000; and 23.7% vs 25.9%, P = 0.624, respectively), as were the 5-year overall survival, disease-free survival, and local recurrence rates (93.1% vs 92.2%, P = 0.422; 79.6% vs 81.8%, P = 0.538; 3.9% vs 5.9%, P = 0.313, respectively).The oncologic quality, short- and long-term outcomes, and postoperative morbidity in the R-TME group were comparable with those in the L-TME group.

A review on robotic surgery in rectal cancer

“…Similar findings were presented in other studies, where robotic surgery was shown to have lower or even a zero conversion rate (20)(21)(22). Despite this, other studies found no difference in conversion rates between robotic and laparoscopic surgery (23)(24)(25)(26).…”

“…Long term OS rate was comparable between laparoscopic and robotic rectal surgery. At least two publications (25,33), have reported similar 5-year OS rates; 93.1% and 93.5% respectively in the laparoscopic arm, and 92.2% and 92.8% respectively in the robotic arm. A 5-year DFS rate was higher in the robotic group for both studies, at about 81%; 78% in the laparoscopic group.…”

Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery

“…Then the remaining 42 articles were subjected to full-text examination and the following studies were further eliminated, including 24 articles without longterm oncologic outcomes, seven studies irrelevant to the comparison of DVSS versus LS/open surgery, and one plan. Finally, 10 eligible articles 5,11,[13][14][15][21][22][23][24][25] were included in the present meta-analysis.…”

“…15 To resolve these inconsistencies, we conducted this meta-analysis to comprehensively evaluate the efficiency of DVSS on CRC treatment, compared with LS and open surgery. Considering that there were too many studies that investigated the short-term outcomes, we mainly focused on the long-term outcomes.…”

Robotic total mesorectal excision – precision surgery with even more precise tools

“…7 Indeed, more recent case-matched studies have demonstrated that short-term perioperative and oncological outcomes are certainly on par if not improved over laparoscopic surgery including those undertaken post chemoradiotherapy. 8,9 Safety and oncological compromise are consistently cited as concerns in novel surgical techniques. However, if these have been addressed, the next challenge is technique and functional outcomes.…”