Systemic review and network meta‐analysis comparing minimal surgical techniques for rectal cancer: quality of total mesorectum excision, pathological, surgical, and oncological outcomes

Rausa, Emanuele; Bianco, Federica; Kelly, Michael E.; Aiolfi, Alberto; Petrelli, Fausto; Bonitta, Gianluca; Sgroi, Giovanni

doi:10.1002/jso.25410

Cited by 22 publications

(31 citation statements)

References 47 publications

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“…Laparoscopic, transanal, and robotic TME also showed similar leak and reoperation rates [67,70] . Postoperative ileus, wound infection, and urinary retention were similar between open, laparoscopic, transanal procedures in comparison with robotic approach [30,65,69] . Length of hospital stay was shorter after robotic surgery compared with open (7.5 days vs. 13.24 days) [66,69] , but no difference was found when comparing it with conventional laparoscopy [28,70] .…”

Section: Postoperative Outcomesmentioning

confidence: 82%

“…Truong et al [73] analysed a retrospective cohort of patients looking at successful resections, defined as a circumferential and distal resection margins < 1 mm and complete mesorectal resection, which were similar between the robotic (75%) and open (76%) approaches [73] . There were no differences in the studies comparing all four approaches for rectal cancer regarding the number of lymph nodes retrieved [26,27,30,69] .…”

Section: Pathologic Outcomesmentioning

confidence: 95%

“…The completeness of the mesorectal resection became a valuable item to assess the oncologic safety of a rectal resection and predicts tumor recurrence in the pelvis [72] . Rausa et al [30] showed no significant differences in complete, near-complete or incomplete mesorectal excision between laparoscopic and robotic approaches (complete RR, 0.8; 95%CI: 0.7-1.0; nearly-complete RR, 1.6; 95%CI: 0.9-2.7; incomplete RR, 1.5; 95%CI: 0.8-2.5) [30] .…”

Section: Pathologic Outcomesmentioning

confidence: 99%

“…Length of hospital stay was shorter after robotic surgery compared with open (7.5 days vs. 13.24 days) [66,69] , but no difference was found when comparing it with conventional laparoscopy [28,70] . Perioperative complications and mortality rates appear to be similar for all four approaches [28,30,69] . Mortality is low in elective rectal surgery, with only 2 cases in each arm among 466 patients (0.9%) in the ROLARR study [26] .…”

Section: Postoperative Outcomesmentioning

confidence: 99%

“…Two recent systematic reviews with meta-analyses summarized the outcomes from 7 and 5 RCTs with a similar design [27,28] . Other metaanalyses have been published including also non-randomized clinical trials [29,30] . No guidelines are now available suggesting the true role of robotics in colorectal surgery, high-quality clinical data is similarly lacking.…”

Section: Introductionmentioning

confidence: 99%

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Robotic total mesorectal excision: state of the art

Sebastián-Tomás¹,

Santarrufina-Martínez²,

Navarro-Martínez³

et al. 2019

MIS

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Minimally-invasive conventional up-to-down laparoscopic approach is a widespread alternative for rectal cancer resection. Its potential benefits towards open surgery have been shown to rely, however, at secondary clinical outcomes, and its oncological non-inferiority compared with the traditional open approach has not been demonstrated yet. In this scenario, robotic-assisted minimally-invasive rectal resection has gained increasing popularity and promising expectancies. This narrative review aims to assemble the most updated evidence available and to discuss the future perspectives and challenges for this emergent surgical tool. The main benefit over conventional laparoscopy appears to be a reduction of conversion rates to open surgery, whereas the oncologic and functional outcomes seem similar than the other alternatives. Increased costs are the main limitation of the widespread of robotic technology. Low quality of the current evidence is remarkable.

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Section: Postoperative Outcomesmentioning

confidence: 82%

Section: Pathologic Outcomesmentioning

confidence: 95%

Section: Pathologic Outcomesmentioning

confidence: 99%

Section: Postoperative Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Robotic total mesorectal excision: state of the art

Sebastián-Tomás¹,

Santarrufina-Martínez²,

Navarro-Martínez³

et al. 2019

MIS

View full text Add to dashboard Cite

show abstract

Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews

Yamamoto

2020

Annals of Gastroent Surgery

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Regarding the surgical approaches for rectal cancer, many techniques have been reported in randomized controlled trials, meta‐analyses, and reviews of comparisons between two techniques, e.g. open surgery vs laparoscopic surgery, laparoscopic surgery vs robotic surgery, or laparoscopic surgery vs transanal total mesorectal excision. Since robotic surgery and transanal total mesorectal excision were developed after laparoscopic surgery had become an established minimally invasive technique, they have each been compared with laparoscopic surgery. Therefore, a review was performed to compare the surgical outcomes of robotic surgery and transanal total mesorectal excision, and to perform such comparisons among ≥3 of the above mentioned approaches, in the expectation that this review will serve as a reference for aiding treatment selection in future. The results of the current review suggest that all of the examined procedures have advantages and disadvantages, but that there are no decisive factors that could be used to select one procedure over any other. At the present time it cannot be demonstrated that laparoscopic surgery, robotic surgery, transanal total mesorectal excision, or open surgery is superior to the other techniques, and it is important to select the best technique for each patient from among those that a surgeon can perform. It is also important to maintain a flexible attitude that allows new techniques to be adopted as needed in the future.

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Cost drivers of locally advanced rectal cancer treatment—An analysis of a leading healthcare insurer

Grass

Merchea

Mathis

et al. 2021

Journal of Surgical Oncology

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Background To evaluate the economic burden of locally advanced rectal cancer (LARC) treatment from a society perspective through analysis of health insurance‐derived data of commercially insured and Medicare Advantage (MA) patients. Methods Retrospective cost analysis of patients undergoing rectal resection within a multimodal (neoadjuvant chemoradiation + adjuvant chemotherapy) treatment strategy between January 1, 2010 and October 31, 2018, using the claims OptumLabs Data Warehouse database. Results In total, 1738 (935 commercial and 803 MA) patients were included. Overall treatment costs totaled $230,881,746 (on average $183 653 ± 82 384 per commercially insured and $73 681 ± 32 917 per MA patient). Cost distribution according to category (commercially insured patients) was: 29.92% related to outpatient care (follow‐up visits/diagnostics), radiotherapy: 21.83%, index resection: 20.62%, chemotherapy: 17.44%, surgical inpatient: 6.32%, medical inpatient: 3.28%, emergency room: 0.58%. Relative cost distribution of the index resection itself differed marginally between the three approaches and was 21.49% for open, 19.30% for laparoscopic, and 20.93% for robotic surgery. Relative cost distributions of neoadjuvant, adjuvant, and outpatient treatments remained unchanged, independently of the surgical approach. This representation was similar in MA patients. Conclusion Index‐surgery related costs were outweighed by costs related to oncological and outpatient workup/follow‐up treatments independently of both surgical approach and insurance type.

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Systemic review and network meta‐analysis comparing minimal surgical techniques for rectal cancer: quality of total mesorectum excision, pathological, surgical, and oncological outcomes

Cited by 22 publications

References 47 publications

Robotic total mesorectal excision: state of the art

Robotic total mesorectal excision: state of the art

Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews

Cost drivers of locally advanced rectal cancer treatment—An analysis of a leading healthcare insurer

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