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Alkhamis AA, Soliman DM, Alsadder KA, Busalha HM, Alrashed AS, Alshaban BH, Alsafran SK, Almazeedi SM. Outcome of Colorectal Robotic Surgery in Newly Established Robotic Surgery Center: A Case Series. Med Princ Pract 2024; 33:000538635. [PMID: 38569485 PMCID: PMC11324209 DOI: 10.1159/000538635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/01/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION The robotic platform compared to laparoscopy has proven to have similar postoperative outcomes, however its adoption in the Middle East has been slow and there is limited data regarding outcomes with its use in small newly established robotic colorectal programs. Our aim was to report our experience and outcomes of robotic colorectal surgery performed by fellowship-trained robotic colorectal surgeons and compare them to larger, more experienced centers. METHODS This is retrospective review of data collected between November 2021 and March 2023 from a tertiary health care referral center. The series included 51 patients who had elective or urgent robotic colorectal surgery. Patients who had emergency surgery were excluded. The outcomes were overall morbidity, serious morbidity, mortality, conversion to open, length of hospital stay, and quality of oncological specimen. RESULTS The overall morbidity was 31.4% (n = 16 patients). Only 9.8% (n = 5) had serious morbidity of which three required interventions under general anesthesia. The median length of hospital stay was 6 days (IQR = 4), and there was no mortality. Of 17 rectal cancer resections, 88% had complete mesorectal excision, 15 of them were R0 resections, median lymph node harvested was 14 (IQR = 7) and two cases were converted to open. All the colon cancer resections had R0 resection, median lymph nodes harvested was 21 (IQR = 4) and none were converted to open. CONCLUSIONS The implementation and integration of robotic colorectal surgery at a newly established center in a small country, when led by fellowship trained robotic colorectal surgeons, is safe and effective in terms of morbidity, mortality, conversion to open and specimen pathological quality.
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Affiliation(s)
- Ahmed A. Alkhamis
- Department of Surgery, College of Medicine, Kuwait University, Jabriya, Kuwait
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Diaa M. Soliman
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Khaled A. Alsadder
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Hashem M. Busalha
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Ahmad S. Alrashed
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Bader H. Alshaban
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Salman K. Alsafran
- Department of Surgery, College of Medicine, Kuwait University, Jabriya, Kuwait
- Endocrine Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
| | - Sulaiman M. Almazeedi
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, South Surra, Kuwait
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Alkhamis A, Soliman D, Alkandari O, Alrashed A, Alansari M, Alsadder K, Chamkha Z, Souza D, AlShaban B, Alsafran S, Almazeedi S. Outcomes in robotic-assisted compared to laparoscopic-assisted colorectal surgery in a newly established colorectal tertiary center: a retrospective comparative cohort study. J Robot Surg 2024; 18:152. [PMID: 38564083 DOI: 10.1007/s11701-024-01908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
The robotic platform matches or surpasses laparoscopic surgery in postoperative results. However, limited date and slow adoption are noticed in the middle east. We aimed to report outcomes of robotic and laparoscopic colorectal surgery performed by fellowship-trained robotic colorectal surgeons and compare it to larger more experienced centers. Retrospective review of prospectively collected data between 2021 and 2023 of 107 patients who had robotic-assisted or laparoscopic-assisted colorectal surgery was included in the study. The outcomes were overall morbidity, serious morbidity, mortality, conversion to open, length of hospital stay, and the quality of oncological specimen. Of 107 patients, 57 were in the robotic and 50 were in the laparoscopic surgery groups. Overall, there were no significant differences in overall morbidity (46.8 vs. 53.2%, p = 0.9), serious morbidity (10.5 vs. 8%, p = 0.7), or mortality (0 vs. 4%, p = 0.2). Regarding oncological outcomes, there were no significant difference between the two groups regarding the number of lymph node harvested (17.7 ± 6.9 vs 19.0 ± 9.7, p = 0.5), R0 resections (92.7 vs. 87.1%, p = 0.5), and the rate of complete mesorectal excision (92.7 vs. 71.4%, p = 0.19). The study found that the robotic group had an 86% reduction in conversion rate to open surgery compared to the laparoscopic group, despite including more obese and physically dependent patients (OR = 0.14, 95% CI 0.03-0.7, p = 0.01). Robotic surgery appears to be a safe and effective as laparoscopic surgery in smaller colorectal surgery programs led by fellowship-trained robotic surgeons, with outcomes comparable to those of larger programs.
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Affiliation(s)
- Ahmed Alkhamis
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, State of Kuwait, Kuwait City, Kuwait.
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait.
| | - Diaa Soliman
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
- Department of General Surgery, University of Arizona, Tucson, AZ, USA
| | - Omar Alkandari
- Kuwait Institute for Medical Specialization, Ministry of Health, Kuwait City, Kuwait
| | - Ahmad Alrashed
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Mohammad Alansari
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Khaled Alsadder
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Zeinab Chamkha
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Dante Souza
- Department of Surgery, TriHealth Good Samaritan Hospital, Cincinnati, OH, USA
| | - Bader AlShaban
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Salman Alsafran
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, State of Kuwait, Kuwait City, Kuwait
- Endocrine Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Sulaiman Almazeedi
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
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Zhang Y, Dong B, Li G, Ye W. Short-term outcomes of robotic vs. laparoscopic surgery for rectal cancer after neoadjuvant therapy: a meta-analysis. Front Surg 2024; 10:1292031. [PMID: 38274354 PMCID: PMC10808682 DOI: 10.3389/fsurg.2023.1292031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Background The effect of robotic surgery (RS) for rectal cancer after neoadjuvant therapy is still controversial, and a comprehensive search and analysis of the current relevant evidence is necessary. Our study aimed to evaluate the efficacy of RS for rectal cancer after neoadjuvant therapy compared with conventional laparoscopic surgery (LS). Methods Up to August 23, 2023, Embase, PubMed, Web of Science, and Cochrane databases were searched for studies of RS for rectal cancer after neoadjuvant therapy. Odds ratio (OR) or mean difference (MD) was used to calculate the effect sizes using RevMan 5.3. Results A total of 12 studies reporting on 11,686 participants were included. Compared with LS, RS increased the operative time (MD 35.16 min; 95% CI: 16.24, 54.07), but it did significantly reduce the risk of the conversion to open surgery (OR 0.46, 95% CI 0.40, 0.53) and improved the TME incomplete rate (OR 0.40, 95% CI 0.17, 0.93). Moreover, there were no difference in total postoperative complications (OR 1.13, 95% CI 0.84, 1.52), circumferential resection margin positivity (OR 0.90, 95% CI 0.63, 1.27), distal margin positive (OR 0.60, 95% CI 0.29, 1.22), blood loss (MD -11.57 ml; 95% CI: -39.09, 15.94), length of hospital stay (MD -0.08 days; 95% CI: -1.26, 1.10), mortality (OR 0.59, 95% CI 0.29, 1.21), lymph node harvested (MD 0.69.; 95% CI: -0.43, 1.82), and the time of first flatus (MD -0.47 days; 95% CI: -1.19, 0.25) between the two groups. Conclusions RS was associated with superiority over LS in reducing the risk of the conversion to open surgery and improving TME incomplete rate, which suggested that RS could be an effective method for treating rectal cancer after neoadjuvant therapy. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=460084, PROSPERO (CRD42023460084).
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Affiliation(s)
| | | | | | - Wei Ye
- Department of General Surgery, People’s Hospital of Rongchang District, Chongqing, China
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Yao Q, Sun QN, Ren J, Wang LH, Wang DR. Comparison of robotic‑assisted versus conventional laparoscopic surgery for mid-low rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2023; 149:15207-15217. [PMID: 37580404 DOI: 10.1007/s00432-023-05228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Scarce research has reported the comparison between robotic and laparoscopic surgery in mid-low rectal cancer. Therefore, this meta-analysis is aimed to compare the safety and efficacy of the two surgical approaches. METHODS A comprehensive search of the databases (PubMed, EMBASE, Cochrane, and Web of Science) was performed for studies comparing robotic and laparoscopic surgery. The outcomes of interest acquired from eight articles included three aspects: intraoperative conditions, postoperative status of patients, and complications. All data (robotic = 1350 patients, laparoscopic = 1330 patients) enrolled were analyzed using Rev Man 5.4. RESULTS Compared to the laparoscopic group, the robotic group indicated a noticeable superiority in estimated blood loss (P < 0.0001), number of lymph nodes dissected (P = 0.004), time to first flatus (P = 0.001), time to first fluid diet (P = 0.001), hospital stay (P < 0.0001), conversion (P = 0.009), and urinary retention (P = 0.0006), but devoted much more operation time (P = 0.0004). CONCLUSION Robotic surgery was associated with superiority over laparoscopic surgery in increasing surgical safety, accelerating postoperative recovery, and reducing complications, which suggested that robotic surgery could be a safe and effective method for treating mid-low rectal cancer.
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Affiliation(s)
- Qing Yao
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Qian-Nan Sun
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
- Medical Research Center of Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Liu-Hua Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Dao-Rong Wang
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China.
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Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, Min BS, Kim NK, Kim SH, Lee KY. Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers: The COLRAR Randomized Controlled Trial. Ann Surg 2023; 278:31-38. [PMID: 36594748 DOI: 10.1097/sla.0000000000005788] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate whether robotic for middle or low rectal cancer produces an improvement in surgical outcomes compared with laparoscopic surgery in a randomized controlled trial (RCT). BACKGROUND There is a lack of proven clinical benefit of robotic total mesorectal excision (TME) compared with a laparoscopic approach in the setting of multicenter RCTs. METHODS Between July 2011 and February 2016, patients diagnosed with an adenocarcinoma located <10 cm from the anal verge and clinically rated T1-4aNxM0 were enrolled. The primary outcome was the completeness of TME assessed by a surgeon and a pathologist. RESULTS The RCT was terminated prematurely because of poor accrual of data. In all, 295 patients were assigned randomly to a robot-assisted TME group (151 in R-TME) or a laparoscopy-assisted TME group (144 in L-TME). The rates of complete TME were not different between groups (80.7% in R-TME, 77.1% in L-TME). Pathologic outcomes including the circumferential resection margin and the numbers of retrieved lymph nodes were not different between groups. In a subanalysis, the positive circumferential resection margin rate was lower in the R-TME group (0% vs 6.1% for L-TME; P =0.031). Among the recovery parameters, the length of opioid use was shorter in the R-TME group ( P =0.028). There was no difference in the postoperative complication rate between the groups (12.0% for R-TME vs 8.3% for L-TME). CONCLUSIONS In patients with middle or low rectal cancer, robotic-assisted surgery did not significantly improve the TME quality compared with conventional laparoscopic surgery (ClinicalTrial.gov ID: NCT01042743).
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Affiliation(s)
- Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Min Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ho Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seon Hahn Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kazi M, Jajoo B, Rohila J, Dohale S, Bhuta P, Desouza A, Saklani A. Functional outcomes after robotic or laparoscopic intersphincteric resection - An inverse probability weighting analysis. Eur J Surg Oncol 2023; 49:196-201. [PMID: 35850943 DOI: 10.1016/j.ejso.2022.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/16/2022] [Accepted: 07/08/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Functional outcomes after robotic and laparoscopic Intersphincteric resections (ISR) have not been studied adequately. We aimed to compare the bowel functions after robotic or laparoscopic ISR. METHODS Single-center, cross-sectional study of minimally invasive ISR. Functional outcomes were assessed on the low anterior resection syndrome (LARS), Wexner incontinence scale, and the Kirwan grading. Baseline characteristics (age, sex, body mass index, T stage, tumour height, preoperative radiation, and anastomotic configuration) in the groups were balanced using inverse probability of treatment weighting (IPTW). RESULTS Functional outcomes were assessed for 132 patients, 85 laparoscopic and 47 robotic ISR were performed. After IPTW, baseline characteristics were well balanced (mean deviation <0.1). In the weighted cohorts of laparoscopic and robotic ISR, major LARS was observed in 18.1% and 18.5% (p - 0.182) and major incontinence on the Wexner scale in 18.4% and 22.8% (p - 0.443), respectively. The Kirwan grades of incontinence were also similar between the groups (p - 0.794). CONCLUSION No differences in bowel functions on the LARS and incontinence scales between laparoscopic and robotic ISR were found in the present study.
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Affiliation(s)
- Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India; Homi Bhabha National Institute, Mumbai, 400012, India
| | - Bhushan Jajoo
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India; Homi Bhabha National Institute, Mumbai, 400012, India
| | - Jitender Rohila
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India; Homi Bhabha National Institute, Mumbai, 400012, India
| | - Sayali Dohale
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India; Homi Bhabha National Institute, Mumbai, 400012, India
| | - Prajesh Bhuta
- Division of Colorectal Surgery, Jaslok Hospital and Research Centre, Mumbai, 400026, India
| | - Ashwin Desouza
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India; Homi Bhabha National Institute, Mumbai, 400012, India
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India; Homi Bhabha National Institute, Mumbai, 400012, India.
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Chen TC, Liang JT. Robotic versus laparoscopic surgery for rectal cancer after neoadjuvant chemoradiotherapy: A propensity-score matching analysis. J Formos Med Assoc 2021; 121:1532-1540. [PMID: 34789424 DOI: 10.1016/j.jfma.2021.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aimed to investigate the advantages of robotic versus laparoscopic surgery for rectal cancer after neoadjuvant chemoradiotherapy as these remains unclear. METHODS We retrospectively recruited eligible patients with rectal cancer undergoing robotic or laparoscopic surgery following neoadjuvant chemoradiotherapy. We compared the surgical outcomes between patients undergoing either robotic surgery or laparoscopic surgery was based on the propensity-score matching analysis. RESULTS A total of 171 patients were recruited, including 76 who underwent robotic surgery and 95 who underwent laparoscopic surgery. There were no significant differences in clinical and pathological characteristics between the groups after propensity-score matching (56 matched pairs). Longer operation times (324.964 ± 83.435 vs. 246.232 ± 111.324 min, p < 0.001) and more blood loss (187.679 ± 176.615 vs. 98.214 ± 107.011, p < 0.001) were observed in the robotic group. The major complication rates were similar between the treatment groups after propensity matching (p = 0.086). There were no significant differences in disease-free survival rates (p = 0.205) and overall survival rates (p = 0.837) between the groups. CONCLUSIONS Robotic surgery is associated with similar technical safety and oncologic efficacy compared to laparoscopic surgery for the treatment of rectal cancer after neoadjuvant chemoradiotherapy; it is an acceptable option for patients requiring minimally invasive surgery. Nevertheless, the longer operation times and greater blood loss seen in the present study are a stark reminder that the convenience and surgical precision, on which the marketing of robotic surgery is rooted, are yet to be proven and require further investigation.
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Affiliation(s)
- Tzu-Chun Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taiwan
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Sphincter-Saving Robotic Total Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal Cancer. Surg Technol Int 2021. [PMID: 33537982 DOI: 10.52198/21.sti.38.cr1391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer. MATERIALS AND METHODS The study was conducted as a retrospective review of a prospectively maintained database. One-hundred-three robotic and 84 laparoscopic sphincter-saving total mesorectal excisions were performed by a single surgeon between January 2011 and January 2020. Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups. RESULTS The patients' characteristics did not differ significantly between the two groups. Median operating time was longer in the robotic than in the laparoscopic group (180 minutes versus 140 minutes, p=0.033). Macroscopic grading of the specimen in the robotic group was complete in 96 (93.20%), near complete in four (3.88%) and incomplete in three (2.91%) patients. In the laparoscopic group, grading was complete in 37 (44.04%), near complete in 40 (47.61%) and incomplete in seven (8.33%) patients (p=0.03). The median length of follow up was 48 (9-102) months in the robotic, and 75.6 (11-113) months in the laparoscopic group. Overall, five-year survival was 87% in the robotic and 85.3% in the laparoscopic groups. Local recurrence rates were 3.8% and 7.14%, respectively, in the robotic and laparoscopic groups (p<0.05). CONCLUSION Sphincter-saving robotic total mesorectal excision is a safe and feasible tool, which provides good mesorectal integrity and better local control in male patients with mid-low rectal cancer.
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Hoshino N, Sakamoto T, Hida K, Takahashi Y, Okada H, Obama K, Nakayama T. Difference in surgical outcomes of rectal cancer by study design: meta-analyses of randomized clinical trials, case-matched studies, and cohort studies. BJS Open 2021; 5:6173855. [PMID: 33724337 PMCID: PMC7962725 DOI: 10.1093/bjsopen/zraa067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/07/2020] [Indexed: 02/01/2023] Open
Abstract
Background RCTs are considered the standard in surgical research, whereas case-matched studies and propensity score matching studies are conducted as an alternative option. Both study designs have been used to investigate the potential superiority of robotic surgery over laparoscopic surgery for rectal cancer. However, no conclusion has been reached regarding whether there are differences in findings according to study design. This study aimed to examine similarities and differences in findings relating to robotic surgery for rectal cancer by study design. Methods A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane CENTRAL to identify RCTs, case-matched studies, and cohort studies that compared robotic versus laparoscopic surgery for rectal cancer. Primary outcomes were incidence of postoperative overall complications, incidence of anastomotic leakage, and postoperative mortality. Meta-analyses were performed for each study design using a random-effects model. Results Fifty-nine articles were identified and reviewed. No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. With respect to the incidence of postoperative overall complications and duration of hospital stay, the superiority of robotic surgery was most evident in cohort studies (risk ratio (RR) 0.83, 95 per cent c.i. 0.74 to 0.92, P < 0.001; mean difference (MD) –1.11 (95 per cent c.i. –1.86 to –0.36) days, P = 0.004; respectively), and least evident in RCTs (RR 1.12, 0.91 to 1.38, P = 0.27; MD –0.28 (–1.44 to 0.88) days, P = 0.64; respectively). Conclusion Results of case-matched studies were often similar to those of RCTs in terms of outcomes of robotic surgery for rectal cancer. However, case-matched studies occasionally overestimated the effects of interventions compared with RCTs.
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Affiliation(s)
- N Hoshino
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Sakamoto
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Y Takahashi
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Okada
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Chen PJ, Su WC, Chang TK, Chen YC, Li CC, Yin TC, Tsai HL, Ma CJ, Huang CW, Wang JY. Oncological outcomes of robotic-assisted total mesorectal excision after neoadjuvant concurrent chemoradiotherapy in patients with rectal cancer. Asian J Surg 2021; 44:957-963. [PMID: 33622595 DOI: 10.1016/j.asjsur.2021.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS This study analyzed the oncological outcomes of robotic-assisted total mesorectal excision (TME) in patients with rectal cancer after neoadjuvant concurrent chemoradiotherapy (CCRT). METHODS We enrolled 109 consecutive patients with stage II-III rectal cancer who underwent robotic-assisted TME after neoadjuvant CCRT at one hospital between July 2013 and June 2018. RESULTS All 109 patients underwent preoperative CCRT. Of them, 37 (33.9%) achieved a pathologic complete response, and 29 (26.6%) experienced relapse, with local recurrence in 9 (8.3%) and distant metastasis in 20 (18.3%). R0 resection was performed in 104 (95.7%) patients; however, 7 (6.7%) of them developed local recurrence and 17 (16.3%) developed distant metastasis. Over a median follow-up of 42 months, the 3-year disease-free survival and overall survival rates were 73.4% and 87.2%, respectively. CONCLUSIONS Robotic-assisted TME after neoadjuvant CCRT is safe and effective for treating patients with stage II-III rectal cancer in one institution with acceptable short-term oncological outcomes. It may be a therapeutic alternative to salvage surgery for T4 tumors invading adjacent organs, such as the bladder, prostate, and uterus.
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Affiliation(s)
- Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan; Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chun Li
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Chieh Yin
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
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11
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Yin TC, Su WC, Chen PJ, Chang TK, Chen YC, Li CC, Hsieh YC, Tsai HL, Huang CW, Wang JY. Oncological Outcomes of Robotic-Assisted Surgery With High Dissection and Selective Ligation Technique for Sigmoid Colon and Rectal Cancer. Front Oncol 2020; 10:570376. [PMID: 33194663 PMCID: PMC7641631 DOI: 10.3389/fonc.2020.570376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Curative resection of sigmoid colon and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the complication rate. We present preliminary experiences of operative and oncologic outcomes of patients with rectal or sigmoid colon cancer who underwent robotic surgery employing the high dissection and selective ligation technique. Methods: Over May 2013 to April 2017, 113 stage I-III rectal or sigmoid colon cancer patients underwent robotic surgery with the single-docking technique at one institution. We performed D3 lymph node dissection and low-tie ligation of the IMA (i.e., high dissection and selective ligation technique). Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Results: Sphincter preservation rate was 96.3% in rectal cancer patients. Median number of harvested lymph nodes was 12. Apical nodes were pathologically harvested in 84 (82.4%) patients. R0 resection was performed in 108 (95.6%) patients. Overall complication rate was 17.7%; but most complications were mild and the patients recovered uneventfully. Estimated 5-year OS was 86.1% and 3-year DFS was 79.6% after median follow-up periods of 49.1 months (range, 5.3-85.3). Conclusions: High dissection of the IMA and selective ligation of the major feeding vessel to the sigmoid colon or rectum can be safely performed using da Vinci Surgical System,yielding favorable clinical, and oncologic outcomes in rectal or sigmoid colon cancer treatment.
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Affiliation(s)
- Tzu-Chieh Yin
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chun Li
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chien Hsieh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Wee IJY, Kuo LJ, Ngu JCY. Urological and sexual function after robotic and laparoscopic surgery for rectal cancer: A systematic review, meta-analysis and meta-regression. Int J Med Robot 2020; 17:1-8. [PMID: 32945090 DOI: 10.1002/rcs.2164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/29/2020] [Accepted: 09/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND This systematic review sought to compare the urogenital functions after laparoscopic (LAP) and robotic (ROB) surgery for rectal cancer. METHODS This study conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Twenty-six studies (n = 2709 for ROB, n = 2720 for LAP) were included. There was a lower risk of 30-day urinary retention in the ROB group (risk ratios 0.78, 95% confidence interval [CI] 0.61-0.99), but the long-term risk was comparable (p = 0.460). Meta-regression showed a small, positive relationship between age and risk of 30-day urinary retention in both the ROB (p = 0.034) and LAP groups (p = 0.004). The International Prostate Symptom Score was better in the ROB group at 3 months (mean difference [MD] -1.58, 95% CI -3.10 to -0.05). The International Index of Erectile Function score was better in the ROB group at 6 months (MD 4.06, 95% CI 2.38 - 5.74). CONCLUSION While robotics may improve urogenital function after rectal surgery, the quality of evidence is low based on the Grading of Recommendations, Assessment, Development and Evaluation approach.
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Affiliation(s)
- Ian Jun Yan Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Li-Jen Kuo
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - James Chi-Yong Ngu
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
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13
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Hsieh C, Cologne KG. Laparoscopic Approach to Rectal Cancer-The New Standard? Front Oncol 2020; 10:1239. [PMID: 32850374 PMCID: PMC7412716 DOI: 10.3389/fonc.2020.01239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Minimally invasive surgery has revolutionized the way surgeons perform colorectal surgery, and new technologies continually upend the way surgeons view and operate within the deep pelvis. Among other benefits, it is associated with decreased lengths of stay, wound and surgical site infections, pain scores, and has an overall lower complication rate vs. open surgery (1). Recently, however, the role of minimally invasive surgery has been called into question in the effective and safe treatment of rectal cancer. This manuscript will outline the history of minimally invasive rectal cancer surgery, examine evidence detailing its safety (compared with alternatives), and discuss important aspects of use, most notably the considerable learning curve required to achieve proficiency, the extent of its current use, and potential pitfalls. The current evidence suggests minimally invasive surgery is a very safe way to treat rectal cancer when performed by experienced and specialty trained surgeons.
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Affiliation(s)
- Christine Hsieh
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kyle G Cologne
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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14
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Chen Z, Zhu ZL, Wang P, Zeng F. Comparison of clinical efficacy between robotic-laparoscopic excision and traditional laparoscopy for rectal cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20704. [PMID: 32629643 PMCID: PMC7337608 DOI: 10.1097/md.0000000000020704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUNDS Laparoscopic surgery, robot-assisted surgery and open surgery are the most commonly consumed surgical techniques in daily living. Considering that in recent years, the situation of choosing laparoscopic surgery and robot-assisted surgery to treat rectal cancer in China is prosperous. Meanwhile, researches lacked in the comparison part between the 2, so we will systematically compare the clinical efficacy of robot-assisted resection and traditional laparoscopic resection for rectal cancer. METHODS AND ANALYSIS We will search Clinical research literature published before January 2020 in PubMed, Embase, the Cochrane library, Science Network, Wan Fang database, Chinese national knowledge infrastructure, and Chinese biomedicine that evaluate the correlation of rectal cancer with Leonardo's robot and traditional laparoscopy, from inception to July 2019. Weighted mean difference and odds ratio were used to compare the efficacy of robot-assisted resection versus conventional laparoscopic resection for rectal cancer, and the main indicators are operation time, complication rate, conversion rate, blood loss, and length of stay. RESULTS AND CONCLUSION This study will systematically evaluate the clinical efficacy of robot-assisted resection and traditional laparoscopic resection for rectal cancer, thus providing evidence to the clinical application. The results will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION No ethical approval and participant consent are required, since this study data is based on published literature. The results of the study will be submitted to a peer-reviewed journal.PROSPERO registration number: CRD42020172161.
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15
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Qiu H, Yu D, Ye S, Shan R, Ai J, Shi J. Long-term oncological outcomes in robotic versus laparoscopic approach for rectal cancer: A systematic review and meta-analysis. Int J Surg 2020; 80:225-230. [PMID: 32251720 DOI: 10.1016/j.ijsu.2020.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Short-term outcomes of robotic mesorectal excision for rectal cancer resection seem comparable to those of conventional laparoscopic mesorectal excision. However, the long-term oncological outcomes of robot mesorectal excision require further investigation. MATERIALS AND METHODS The PubMed, EMBASE, Medline, and Cochrane Library databases were searched from the date of database inception to March 31, 2019 for all available trials; the results of robotic and laparoscopic mesorectal excision for rectal cancer surgery were compared. Survival parameters, including overall survival (OS) and disease-free survival (DFS), were independently extracted by two investigators. Hazard ratios (HRs) were calculated using random- or fixed-effects models. The presence of heterogeneity was assessed using Q test, and the extent of heterogeneity was quantified by I2 index. The meta-analysis was performed using Review Manager software, version 5.3. RESULTS A total of seven studies including 2593 patients (1362 treated by robotic mesorectal excision and 1231 by laparoscopic mesorectal excision) were included. Pooled analyses showed no significant difference in OS (HR = 0.94, 95% confidence interval [CI]: 0.63 to 1.39, P = 0.75) or DFS (HR = 0.93, 95% CI: 0.79 to 1.10, P = 0.85) between the robotic and laparoscopic mesorectal excision for treatment of rectal cancer. CONCLUSION Regarding long-term survival, robotic mesorectal excision for rectal cancer is comparable to laparoscopic mesorectal excision. More prospective, multicenter randomized trials with longer follow-up periods are needed to determine the long-term outcomes of patients undergoing robotic mesorectal excision.
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Affiliation(s)
- Hua Qiu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China; Jiangxi Medical College of Nanchang University, Nanchang University Health Science Center, Nanchang, 330006, Jiangxi Province, China
| | - Dongjun Yu
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Shanping Ye
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China; Jiangxi Medical College of Nanchang University, Nanchang University Health Science Center, Nanchang, 330006, Jiangxi Province, China
| | - Renfeng Shan
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Junhua Ai
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Jun Shi
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
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16
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Wang Y, Wang J. Current and Future Robotic Surgery Platforms: Introduction of keynote speech at 2019 Mayo Clinic-SRRSH Global Robotic & Endoscopic Surgery Summit. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Noh GT, Oh BY, Han M, Chung SS, Lee RA, Kim KH. Initial clinical experience of single-incision robotic colorectal surgery with da Vinci SP platform. Int J Med Robot 2020; 16:e2091. [PMID: 32048755 DOI: 10.1002/rcs.2091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was introduced to overcome the limitations of single-incision laparoscopic surgery, which is challenging due to its restrictions regarding triangulation and retraction. The purpose of this article is to describe the initial experience with single-incision surgery using the da Vinvci Single-Port Platform (dVSP). METHODS The medical records of patients with colorectal disease, who underwent single-incision robotic surgery using the dVSP, were retrospectively reviewed. RESULTS Five patients with appendiceal and colorectal cancer, and two with diverticulitis were enrolled. All procedures were completed using a pure single-incision approach, with an exception for low anterior resection. There were two minor complications. For patients with colorectal cancer, the number of retrieved lymph nodes and status of the resection margin were acceptable, and cosmetic results were satisfactory. CONCLUSION The dVSP is a novel surgical platform that can be used as an alternative surgical modality for colorectal surgery.
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Affiliation(s)
- Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Bo-Young Oh
- Department of Surgery, Hallym University College of Medicine, Chuncheon-si, South Korea
| | - Myunghyun Han
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Kwang Ho Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
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18
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Aliyev V, Tokmak H, Goksel S, Meric S, Acar S, Kaya H, Asoglu O. The long-term oncological outcomes of the 140 robotic sphincter-saving total mesorectal excision for rectal cancer: a single surgeon experience. J Robot Surg 2019; 14:655-661. [PMID: 31811567 DOI: 10.1007/s11701-019-01037-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/02/2019] [Indexed: 02/01/2023]
Abstract
Robotic surgery became more popularly in the colorectal surgical field. The aim of the study was to evaluate of the oncological outcomes which patients who underwent the robotic total mesorectal excision for rectal cancer. A series of 140 consecutive patients who underwent robotic rectal surgery between January 2012 and June 2019 was analyzed retrospectively in terms of demographics, pathological data, and surgical and oncological outcomes. There were 104 (74.28%) male and 36 (25.71%) female patients. The tumor was located in the lower rectum in 84 (60%) cases, in the mid rectum in 38 (27.14%) cases, and in the upper rectum in 18 (12.85%) cases. Ninety-eight (70%) of the patients has received neoadjuvant chemoradiotherapy. All the patients underwent robotic sphincter-preserving surgery, 101 (72.14%) patients low-anterior resection, and 39 (27.85%) patients underwent intersphincteric resection with colo-anal anastomosis. There were no conversions. The circumferential resection margin was positive in five (3.57%) patients. The median distal resection margin of the operative specimen was 3.2 (0.2-7) cm. The median number of retrieved lymph nodes was 22 (16-42). TME quality in the in our study was rated as complete in 88.57% (n124) of patients, nearly complete in 7.14% (n10) of patients; and 4.28% (n6) of incomplete. The median hospital stay was 3.5 (3-12) days. In-hospital and 1-month mortality was zero. The median length of follow-up was 40 (2-80) months. The 5-year overall survival rate was 92.78%. The 5-year disease-free survival rate was 90%. Locally recurrence and distance recurrence rate was 3.57% (n5/140) and 2.85% (n4/140), respectively. Robotic rectal cancer surgery has a good oncological outcomes and feasible tool in the field of the rectal surgery, but required a steep learning curve.
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Affiliation(s)
- Vusal Aliyev
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Handan Tokmak
- Department of Nuclear Medicine, Maslak Acıbadem Hospital, Istanbul, Turkey
| | - Suha Goksel
- Department of Pathology, Maslak Acıbadem Hospital, Istanbul, Turkey
| | - Serhat Meric
- Department of General Surgery, Health Sciences University Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Sami Acar
- Department of General Surgery, Taksim Acıbadem Hospital, Istanbul, Turkey
| | - Hakan Kaya
- Department of General Surgery, Maslak Acıbadem Hospital, Istanbul, Turkey
| | - Oktar Asoglu
- Bosphorus Clinical Research Academy, Vişnezade Mah., Acısus Sokak, Salihbey Apt. No:16/D:5, Beşiktaş, Istanbul, Turkey.
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19
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Asoglu O, Tokmak H, Bakir B, Aliyev V, Saglam S, Iscan Y, Bademler S, Meric S. Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes. J Robot Surg 2019; 14:393-399. [PMID: 31313071 DOI: 10.1007/s11701-019-01001-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Oktar Asoglu
- Bosphorus Clinical Research Academy, Vişnezade Mah., Acısus Sokak, Salihbey Apt. No:16/D:5. Beşiktaş, Istanbul, Turkey.
| | - Handan Tokmak
- Department of Nuclear Medicine, Acıbadem University Macka Hospital, Istanbul, Turkey
| | - Baris Bakir
- Department of Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Vusal Aliyev
- Bosphorus Clinical Research Academy, Vişnezade Mah., Acısus Sokak, Salihbey Apt. No:16/D:5. Beşiktaş, Istanbul, Turkey
- Department of General Surgery, Florence Nightingale Hospital, Istanbul, Turkey
| | - Sezer Saglam
- Department of Medical Oncology, Florence Nightingale Hospital, Istanbul, Turkey
| | - Yalın Iscan
- Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Suleyman Bademler
- Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Serhat Meric
- Department of General Surgery, Health Sciences University Bagcılar Training and Research Hospital, Istanbul, Turkey
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20
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Wells KO, Peters WR. Minimally Invasive Surgery for Locally Advanced Rectal Cancer. Surg Oncol Clin N Am 2019; 28:297-308. [DOI: 10.1016/j.soc.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Wang L, Zhang Z, Gong L, Zhan Y, Li M, Li S, Xiao Y. A Systematic Review and Bayesian Network Meta-Analysis: Short-Term and Long-Term Outcomes of Three Surgery Procedures Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:663-670. [PMID: 30648922 DOI: 10.1089/lap.2018.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: Our aim was to perform a Bayesian network meta-analysis of short-term and long-term outcomes of open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) after neoadjuvant chemoradiotherapy (nCRT) for rectal cancer. Methods: We searched randomized controlled trials (RCTs) and non-RCTs published up to October 2018 from PubMed, Embase, Cochrane Library, and Web of Science. We selected studies referencing the comparison between at least two of OS, LS, and RS. Short-term and long-term outcomes of different surgery procedures were evaluated. Mean differences or odds ratios and their 95% credible interval were pooled with Bayesian modeling. Results: In the network meta-analysis, 15 studies were identified through database searching and other sources that included three RCTs and nine non-RCTs enrolling 2360 patients. As for long-term outcomes, we did not find any significant difference among these surgery procedures after nCRT for rectal cancer in this network meta-analysis. As for short-term outcomes, no significant outcomes were obtained except for operative time, blood loss, length of incision, and time to pass first flatus. Our meta-analysis illustrated that RS had the longest operative time. However, LS had a significantly shorter operative time than RS, shorter incision than OS, shorter time to pass first flatus than OS, and less blood loss than OS. Conclusions: RS was regarded as the inferior surgery procedure after nCRT for rectal cancer. Meanwhile, LS might possibly be the most safe and feasible surgery procedure after nCRT for rectal cancer.
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Affiliation(s)
- Ling Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhen Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Lian Gong
- Department of Radiotherapy, Sun Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuting Zhan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mengqing Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuman Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongbo Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Abstract
Colon cancer is the second leading cause of cancer death in the United States. Advances in surgical resection techniques, including minimally invasive colectomy, are becoming a standard of care. The oncologic principles of colectomy have included adequate lymphadenectomy, proximal ligation of primary vessels, and resection with adequate longitudinal margins. More recently, complete mesocolic excision has been advocated. Open and minimally invasive approaches must accomplish the same outcomes. This article focuses on the surgical principles of colon cancer, perioperative considerations, and technical aspects of minimally invasive colectomy. We review the current literature regarding oncologic and short-term outcomes of minimally invasive surgery.
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Affiliation(s)
- Katerina O Wells
- Department of Surgery, Baylor University Medical Center, 3409 Worth Street, Suite 640, Dallas, TX 75246, USA.
| | - Anthony Senagore
- Department of Surgery, Western Michigan University, Homer Stryker School of Medicine, 1903 Western Michigan Avenue, Kalamazoo, MI 49008, USA
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23
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Ohtani H, Maeda K, Nomura S, Shinto O, Mizuyama Y, Nakagawa H, Nagahara H, Shibutani M, Fukuoka T, Amano R, Hirakawa K, Ohira M. Meta-analysis of Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer. ACTA ACUST UNITED AC 2018; 32:611-623. [PMID: 29695568 DOI: 10.21873/invivo.11283] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIM A meta-analysis was conducted to evaluate and compare the short- and long-term outcomes of robot-assisted (RAS) and conventional laparoscopic surgery (LAS) for rectal cancer. MATERIALS AND METHODS We searched MEDLINE for relevant papers published between 2010 and December 2017 by using specific search terms. We analyzed outcomes over short- and long-term periods. RESULTS We identified 23 papers reporting results that compared RAS for rectal cancer with LAS. Our meta-analysis included 4,348 patients with rectal cancer; 2,068 had undergone RAS, and 2,280 had undergone LAS. In the short- and long-term period, 27 and 7 outcome variables were examined, respectively. RAS for rectal cancer was significantly associated with a greater operative time and a lower conversion rate to open surgery in the short-term, and results in almost similar outcomes in the long-term, compared to LAS. CONCLUSION RAS may be an acceptable surgical treatment option compared to LAS for rectal cancer.
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Affiliation(s)
- Hiroshi Ohtani
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Nomura
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | - Osamu Shinto
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | - Yoko Mizuyama
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | | | - Hisashi Nagahara
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsune Shibutani
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryosuke Amano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
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24
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Cleary RK, Morris AM, Chang GJ, Halverson AL. Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach? Ann Surg Oncol 2018; 25:3587-3595. [DOI: 10.1245/s10434-018-6740-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/15/2022]
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25
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Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furutani A, Manabe S, Yamaoka Y, Hino H. Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 2018; 32:4498-4505. [PMID: 29721748 DOI: 10.1007/s00464-018-6197-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 04/21/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The long-term outcomes of robotic-assisted laparoscopic lateral lymph node dissection (RALLD) have not been fully investigated. This study aimed to assess the oncological and long-term outcomes of RALLD for rectal cancer through comparison with those of open lateral lymph node dissection (OLLD) in a retrospective study. METHODS Between September 2002 and October 2014, the medical data of 426 patients who underwent total mesorectal excision with lateral lymph node dissection for primary rectal cancer were collected. Of these, 115 patients were excluded after data collection (stage IV, n = 61; total pelvic exenteration, n = 31; multiple cancer, n = 20; conventional laparoscopic surgery, n = 3). Before matching, 311 patients with clinical stage II/III were analyzed. Using exact matching, patients were stratified into RALLD (n = 78) and OLLD (n = 78) groups. Pathological findings and long-term outcomes were compared between the groups. RESULTS The pathological stage and number of harvested lymph nodes showed no significant differences between the groups. The rate of positive resection margin in the RALLD group tended to be lower compared with that of the OLLD group (p = 0.059). The median follow-up duration was 54.0 months in 156 patients. The 5-year overall survival rate was 95.4 and 87.8% in the RALLD and OLLD groups, respectively (p = 0.106). The 5-year relapse-free survival rate was 79.1 and 69.9% in the RALLD and OLLD groups, respectively (p = 0.157). The 5-year local relapse-free survival rate was 98.6 and 90.9% in the RALLD and OLLD groups, respectively (p = 0.029). CONCLUSIONS The short- and long-term outcomes indicated that RALLD may be a useful modality for locally advanced low rectal cancer.
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Affiliation(s)
- Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.,Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. .,Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yushi Yamakawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akinobu Furutani
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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26
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Huang CW, Tsai HL, Yeh YS, Su WC, Huang MY, Huang CM, Chang YT, Wang JY. Robotic-assisted total mesorectal excision with the single-docking technique for patients with rectal cancer. BMC Surg 2017; 17:126. [PMID: 29208050 PMCID: PMC5716256 DOI: 10.1186/s12893-017-0315-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background The robotic system has advantages of high-definition three-dimensional vision and articular instruments with high dexterity, allowing more precise dissection in the deep and narrow pelvic cavity. Methods We enrolled 95 patients with stage I-III rectal cancer (adenocarcinoma) who underwent totally robotic-assisted total mesorectal excision (TME) with single-docking technique at a single institution between September 2013 and December 2016. Results Of the 95 patients, 48 (50.5%) and 30 (31.6%) patients had lower and middle rectal cancers, respectively. Of the 75 (78.9%) patients undergoing preoperative concurrent chemoradiotherapy (CCRT), 27 (28.4%) exhibited pathologic complete response (pCR). Only four (4.2%) patients underwent abdominoperineal resection and the sphincter preservation rate was 95.8%. R0 resection was performed in 92 (96.8%) patients. Circumferential resection margin (CRM) and distal resection margin (DRM) were positive in 2 (2.1%) and 1 (1.1%) patients, respectively. The anastomotic leakage rate was 5.4% (5/95 patients). The overall complication rate was 17.9% (17/95 patients); most of them were mild. No 30-day hospital mortality occurred, and no patients required conversion to open surgery. In 92 patients undergoing R0 resection, 2-year overall survival was 94% and 2-year disease-free survival was 83%. Conclusions The results demonstrated that totally robotic-assisted TME with the single-docking technique is safe and feasible for patients with rectal cancer, with or without preoperative CCRT. Moreover, favorable pCR rate, R0 resection rate, CRM, DRM, sphincter preservation rate, and short-term oncological outcomes can be achieved by combining this approach with appropriate preoperative CCRT.
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Affiliation(s)
- Ching-Wen Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General Surgery Medicine, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ming Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Tang Chang
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Research Center for Natural products & Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan.
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27
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Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malavé L, Ferri V, Nuñez J, Ruiz-Ocaña A, Jorge E, Lazzaro S, Kalivaci D, Quijano Y, Vicente E. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs. Int J Colorectal Dis 2017; 32:1423-1429. [PMID: 28791457 DOI: 10.1007/s00384-017-2876-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis. METHODS This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded. RESULTS A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection. CONCLUSION Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain.
| | - H Duran
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Diaz
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - I Fabra
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - R Caruso
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - L Malavé
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - V Ferri
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - J Nuñez
- (IVEC) Instituto de Validación de la Eficiencia Clínica, Fundación de Investigación HM Hospitales, Plaza del Conde de valle de Suchil 2, 28015, Madrid, Spain
| | - A Ruiz-Ocaña
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Jorge
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - S Lazzaro
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - D Kalivaci
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - Y Quijano
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Vicente
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
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Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer. Ann Surg 2017; 263:1152-8. [PMID: 26501702 DOI: 10.1097/sla.0000000000001388] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine survival of patients who underwent minimally invasive versus open low anterior resection (LAR) for rectal cancer. BACKGROUND Utilization of laparoscopic and robotic LAR for rectal cancer has steadily increased. Short-term outcomes between these techniques and open surgery have shown equivalent results; however, survival outcomes are unknown. METHODS Adults from the National Cancer Data Base undergoing LAR for rectal adenocarcinoma were identified. Patients were stratified by intent-to-treat into open (OLAR) or minimally invasive LAR (MI-LAR). Multivariable modeling was used to compare short-term outcomes and survival between MI-LAR and OLAR and between laparoscopic (LLAR) and robotic LAR (RLAR). RESULTS Among 14,033 patients included, 57.8% underwent OLAR and 42.2% MI-LAR. After adjustment, MI-LAR was associated with shorter length of stay (P < 0.001), but similar rates of positive margins, 30-day readmission, 30-day mortality, and use of adjuvant therapies (all P > 0.05). At 36 months, there was no difference in adjusted risk of mortality between MI-LAR and OLAR (hazard ratio [HR] 0.88, P = 0.089). In a subgroup analysis of LLAR versus RLAR, there were no differences in lymph node harvest, margin positivity, length of stay, readmission rate, 30-day mortality, or overall survival after adjustment (all P > 0.05). CONCLUSIONS Minimally invasive LAR for rectal cancer is associated with similar overall survival with the benefit of shorter hospitalization. Although the conversion rate is lower, robotic LAR is not associated with superior oncologic outcomes compared to laparoscopic LAR. Our findings support the ongoing adoption of minimally invasive techniques for rectal adenocarcinoma.
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29
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Holzmacher JL, Luka S, Aziz M, Amdur RL, Agarwal S, Obias V. The Use of Robotic and Laparoscopic Surgical Stapling Devices During Minimally Invasive Colon and Rectal Surgery: A Comparison. J Laparoendosc Adv Surg Tech A 2017; 27:151-155. [DOI: 10.1089/lap.2016.0409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jeremy L. Holzmacher
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Samuel Luka
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Madiha Aziz
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Richard L. Amdur
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Samir Agarwal
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Vincent Obias
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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30
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Abu Gazala M, Wexner SD. Re-appraisal and consideration of minimally invasive surgery in colorectal cancer. Gastroenterol Rep (Oxf) 2017; 5:1-10. [PMID: 28567286 PMCID: PMC5444240 DOI: 10.1093/gastro/gox001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/13/2022] Open
Abstract
Throughout history, surgeons have been on a quest to refine the surgical treatment options for their patients and to minimize operative trauma. During the last three decades, there have been tremendous advances in the field of minimally invasive colorectal surgery, with an explosion of different technologies and approaches offered to treat well-known diseases. Laparoscopic surgery has been shown to be equal or superior to open surgery. The boundaries of laparoscopy have been pushed further, in the form of single-incision laparoscopy, natural-orifice transluminal endoscopic surgery and robotics. This paper critically reviews the pathway of development of minimally invasive surgery, and appraises the different minimally invasive colorectal surgical approaches available to date.
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Affiliation(s)
- Mahmoud Abu Gazala
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D. Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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31
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Staderini F, Foppa C, Minuzzo A, Badii B, Qirici E, Trallori G, Mallardi B, Lami G, Macrì G, Bonanomi A, Bagnoli S, Perigli G, Cianchi F. Robotic rectal surgery: State of the art. World J Gastrointest Oncol 2016; 8:757-771. [PMID: 27895814 PMCID: PMC5108978 DOI: 10.4251/wjgo.v8.i11.757] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words “rectum”, “rectal”, “cancer”, “laparoscopy”, “robot”. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.
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Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc 2016. [PMID: 27631313 DOI: 10.1007/s00464‐016‐5165‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PROPOSE The use of robotic surgery and neoadjuvant chemoradiation therapy (CRT) for rectal cancer is increasing steadily worldwide. However, there are insufficient data on long-term outcomes of robotic surgery in this clinical setting. The aim of this study was to compare the 5-year oncological outcomes of laparoscopic vs. robotic total mesorectal excision for mid-low rectal cancer after neoadjuvant CRT. MATERIALS AND METHODS One hundred thirty-eight patients who underwent robotic (n = 74) or laparoscopic (n = 64) resections between January 2006 and December 2010 for mid and low rectal cancer after neoadjuvant CRT were identified from a prospective database. The long-term oncological outcomes of these patients were analyzed using prospective follow-up data. RESULTS The median follow-up period was 56.1 ± 16.6 months (range 11-101). The 5-year overall survival (OS) rate of the laparoscopic and robotic groups was 93.3 and 90.0 %, respectively, (p = 0424). The 5-year disease-free survival (DFS) rate was 76.0 % (laparoscopic) vs. 76.8 % (robotic) (p = 0.834). In a subgroup analysis according to the yp-stage (complete pathologic response, yp-stage I, yp-stage II, or yp-stage III), the between-group oncological outcomes were not significantly different. The local recurrence rate was 6.3 % (laparoscopic, n = 4) vs. 2.7 % (robotic, n = 2) (p = 0.308). The systemic recurrence rate was 15.6 % (laparoscopic, n = 10) vs. 18.9 % (robotic, n = 14) (p = 0.644). All recurrences occurred within less than 36 months in both groups. The median period of recurrence was 14.2 months. CONCLUSION Robotic surgery for rectal cancer after neoadjuvant CRT can be performed safely, with long-term oncological outcomes comparable to those obtained with laparoscopic surgery. More large-scale studies and long-term follow-up data are needed.
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33
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Lim DR, Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc 2016; 31:1728-1737. [PMID: 27631313 DOI: 10.1007/s00464-016-5165-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/30/2016] [Indexed: 02/01/2023]
Abstract
PROPOSE The use of robotic surgery and neoadjuvant chemoradiation therapy (CRT) for rectal cancer is increasing steadily worldwide. However, there are insufficient data on long-term outcomes of robotic surgery in this clinical setting. The aim of this study was to compare the 5-year oncological outcomes of laparoscopic vs. robotic total mesorectal excision for mid-low rectal cancer after neoadjuvant CRT. MATERIALS AND METHODS One hundred thirty-eight patients who underwent robotic (n = 74) or laparoscopic (n = 64) resections between January 2006 and December 2010 for mid and low rectal cancer after neoadjuvant CRT were identified from a prospective database. The long-term oncological outcomes of these patients were analyzed using prospective follow-up data. RESULTS The median follow-up period was 56.1 ± 16.6 months (range 11-101). The 5-year overall survival (OS) rate of the laparoscopic and robotic groups was 93.3 and 90.0 %, respectively, (p = 0424). The 5-year disease-free survival (DFS) rate was 76.0 % (laparoscopic) vs. 76.8 % (robotic) (p = 0.834). In a subgroup analysis according to the yp-stage (complete pathologic response, yp-stage I, yp-stage II, or yp-stage III), the between-group oncological outcomes were not significantly different. The local recurrence rate was 6.3 % (laparoscopic, n = 4) vs. 2.7 % (robotic, n = 2) (p = 0.308). The systemic recurrence rate was 15.6 % (laparoscopic, n = 10) vs. 18.9 % (robotic, n = 14) (p = 0.644). All recurrences occurred within less than 36 months in both groups. The median period of recurrence was 14.2 months. CONCLUSION Robotic surgery for rectal cancer after neoadjuvant CRT can be performed safely, with long-term oncological outcomes comparable to those obtained with laparoscopic surgery. More large-scale studies and long-term follow-up data are needed.
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Affiliation(s)
- Dae Ro Lim
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Uk Bae
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
- Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Hyuk Hur
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyuk Baik
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Kyu Kim
- Colon and Rectal Surgery Section, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
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Huang J, Zhang Z, Wang S. Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery. INT J ADV ROBOT SYST 2016. [DOI: 10.1177/1729881416664849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In order to compare the curative effect of the Da Vinci surgical system (DVSS) with laparoscopic surgery (LS) or open surgery for colorectal resection, literature search was conducted in PubMed, Excerpt Medica Database (Embase), and Cochrane library up to January 15, 2016. Odds ratio (OR) and weighted mean difference with their corresponding 95% confidence intervals were used as effect size for evaluation of different outcomes. In total, 10 studies consisting of 2767 patients were included for the meta-analysis. As a result, there were no significant differences between DVSS and LS/open surgery in the long-term oncologic outcomes ( p > 0.05). However, DVSS achieved a significantly lower length of hospital stay and estimated blood loss (EBL), but a longer operation time. Moreover, DVSS showed a significantly reduced conversion to open surgery than LS (OR = 0.19, 95% confidence interval: 0.08–0.48). Subgroup analysis indicated that DVSS had different results in rectal adenocarcinoma and colon cancer subgroups on outcomes of conversion to open surgery and operation time. DVSS is superior to LS/open surgery in length of hospital stay and EBL, but needs longer operation time. Long-term outcomes of DVSS are comparable with the other approaches. From long-term perspective, DVSS has an equivalent effect to the other two techniques.
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Affiliation(s)
- Jintang Huang
- Guizhou Provincial People’s Hospital, Guiyang, China
| | | | - Shaoyong Wang
- Guizhou Provincial People’s Hospital, Guiyang, China
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35
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Minig L, Zanagnolo V, Cárdenas-Rebollo J, Colombo N, Maggioni A. Feasibility of robotic radical hysterectomy after neoadjuvant chemotherapy in women with locally advanced cervical cancer. Eur J Surg Oncol 2016; 42:1372-7. [DOI: 10.1016/j.ejso.2016.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/03/2016] [Accepted: 04/18/2016] [Indexed: 12/27/2022] Open
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36
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Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 2016; 30:5601-5614. [PMID: 27402096 DOI: 10.1007/s00464-016-4892-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Robotic surgery is positioned at the cutting edge of minimally invasive management of colorectal cancer. We performed a meta-analysis of data from randomized controlled trials (RCTs) and non-RCTs (NRCTs) that compared the clinicopathological outcomes of robotic-assisted colorectal surgery (RACS) with those of laparoscopic-assisted colorectal surgery (LACS). Inferences on the feasibility and the relative safety and efficacy have been drawn. METHODS A literature search for relevant studies was performed on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. Inter-group differences in the standardized mean differences and relative risk were assessed. Operation times, conversion rates to open surgery, estimated blood loss (EBL), early postoperative morbidity, and length of hospital stay (LHS) were compared. Oncologic outcomes assessed were number of lymph nodes harvested and lengths of proximal and distal resection margins. RESULTS Twenty-four studies (2 RCTs and 22 NRCTs [5 prospective plus 17 retrospective]) with a total of 3318 patients were included. Of these, 1466 (44.18 %) patients underwent RACS and 1852 (55.82 %) underwent LACS. Conversion rates, EBL and LHS were significantly lower, while the operation times and total costs were similar between RACS and LACS. Complication rates and oncological accuracy of resection showed no significant difference. CONCLUSION Based on this meta-analysis, RACS appears to be a promising surgical approach with its safety and efficacy comparable to that of LACS in patients undergoing colorectal surgery. Further studies are required to evaluate the long-term cost-efficiency as well as the functional and oncologic outcomes of RACS.
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Becker T, Egberts JE, Schafmayer C, Aselmann H. Roboterassistierte Rektumchirurgie: Hype oder Fortschritt? Chirurg 2016; 87:567-72. [DOI: 10.1007/s00104-016-0220-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Huang CW, Yeh YS, Su WC, Tsai HL, Choy TK, Huang MY, Huang CM, Wu IC, Hu HM, Hsu WH, Su YC, Wang JY. Robotic surgery with high dissection and low ligation technique for consecutive patients with rectal cancer following preoperative concurrent chemoradiotherapy. Int J Colorectal Dis 2016; 31:1169-77. [PMID: 27055659 DOI: 10.1007/s00384-016-2581-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE We present the preliminary experiences with and short-term outcomes of 50 consecutive patients with rectal cancer who underwent preoperative concurrent chemoradiotherapy (CCRT) followed by robotic surgery by using the high dissection and low ligation technique. METHODS Between October 2013 and August 2015, 50 patients with rectal cancer underwent robotic surgery after preoperative CCRT at a single institution. We performed D3 lymph node dissection and low tie ligation of the inferior mesenteric artery (IMA); this technique is referred to as the high dissection and low ligation technique. Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed. RESULTS FOLFOX regimen was used for preoperative CCRT in 26 (52 %) patients. Long-course radiotherapy was concurrently administered. A pathological complete response (pCR) was obtained in 14 (28 %) patients. Of the 50 patients, 23 (46 %) patients received intersphincteric resection (ISR) with coloanal anastomosis, 25 (50 %) patients received lower anterior resection (LAR), and 2 (4 %) patients received abdominoperineal resection (APR). Apical nodes were pathologically harvested in 47 (94 %) patients, and the median number of harvested apical lymph nodes was 2 (range, 0-10). The overall complication rate was 24 % (10 patients with 12 episodes), and most complications were mild. CONCLUSION Roboic rectal surgery combined with appropriate preoperative CCRT helps in achieving a favorable pCR, circumferential resection margin, and sphincter preservation. Moreover, high dissection and low ligation of the IMA can be safely performed using the da Vinci(®) Surgical System safely which yield favorable short-term clinical outcomes.
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Affiliation(s)
- Ching-Wen Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General Surgery Medicine, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tak-Kee Choy
- Division of Colorectal Surgery, Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ming Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chung Su
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Abstract
BACKGROUND Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population. STUDY DESIGN A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group. RESULTS Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: -27.63 to -1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate. CONCLUSIONS The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.
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Affiliation(s)
- Becky B Trinh
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nicole R Jackson
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Adam T Hauch
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tian Hu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Robotic Low Anterior Resection for Rectal Cancer: A National Perspective on Short-term Oncologic Outcomes. Ann Surg 2016; 262:1040-5. [PMID: 25405559 DOI: 10.1097/sla.0000000000001017] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study examines short-term outcomes and pathologic surrogates of oncologic results among patients undergoing robotic versus laparoscopic low anterior resection for rectal cancer. A total of 6403 patients met inclusion criteria. Although the robotic approach required significantly fewer conversions to open, surrogates for proper oncologic surgery were nearly identical between the 2 approaches. BACKGROUND Although laparoscopic low anterior resection (LLAR) has gained popularity as an acceptable approach, the robotic low anterior resection (RLAR) remains largely unproven. We compared short-term oncologic outcomes between rectal cancer patients undergoing either RLAR or LLAR. STUDY DESIGN All patients with rectal cancer in the National Cancer Data Base undergoing RLAR or LLAR from 2010 to 2011 were included. Predictors of RLAR were modeled with multivariable logistic regression. Groups were matched on propensity to undergo RLAR. Primary endpoints included lymph node retrieval and margin status, whereas secondary 30-day outcomes were mortality, hospital length of stay (LOS), and unplanned readmission rates. RESULTS A total of 6403 patients met inclusion criteria, of which 956 (14.9%) underwent RLAR. RLAR patients were more likely to be treated at academic centers, receive neoadjuvant therapy, and have higher T-stage and longer time to surgery (all P < 0.001). Neoadjuvant therapy and treatment at an academic/research center remained the only significant predictors of robotic use after multivariable adjustment. After propensity matching, RLAR was associated with lower conversion (9.5 vs 16.4%, P < 0.001). There were no significant differences in lymph node retrieval, margin status, 30-day mortality, readmission, or hospital LOS. CONCLUSIONS In this largest series to date, we demonstrated equivalent perioperative safety and patient outcomes for robotic compared to LLAR in the setting of rectal cancer. Although the robotic approach required significantly fewer conversions to open, surrogates for proper oncologic surgery were nearly identical between the 2 approaches, suggesting that a robotic approach may be a suitable alternative. Further studies comparing long-term cancer recurrence and survival should be performed.
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Guerra F, Pesi B, Amore Bonapasta S, Perna F, Di Marino M, Annecchiarico M, Coratti A. Does robotics improve minimally invasive rectal surgery? Functional and oncological implications. J Dig Dis 2016; 17:88-94. [PMID: 26749061 DOI: 10.1111/1751-2980.12312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Robot-assisted surgery has been reported to be a safe and effective alternative to conventional laparoscopy for the treatment of rectal cancer in a minimally invasive manner. Nevertheless, substantial data concerning functional outcomes and long-term oncological adequacy is still lacking. We aimed to assess the current role of robotics in rectal surgery focusing on patients' functional and oncological outcomes. METHODS A comprehensive review was conducted to search articles published in English up to 11 September 2015 concerning functional and/or oncological outcomes of patients who received robot-assisted rectal surgery. All relevant papers were evaluated on functional implications such as postoperative sexual and urinary dysfunction and oncological outcomes. RESULTS Robotics showed a general trend towards lower rates of sexual and urinary postoperative dysfunction and earlier recovery compared with laparoscopy. The rates of 3-year local recurrence, disease-free survival and overall survival of robotic-assisted rectal surgery compared favourably with those of laparoscopy. CONCLUSIONS This study fails to provide solid evidence to draw definitive conclusions on whether robotic systems could be useful in ameliorating the outcomes of minimally invasive surgery for rectal cancer. However, the available data suggest potential advantages over conventional laparoscopy with reference to functional outcomes.
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Affiliation(s)
- Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Stefano Amore Bonapasta
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Federico Perna
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Michele Di Marino
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
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Petz W, Spinoglio G, Choi GS, Parvaiz A, Santiago C, Marecik S, Giulianotti PC, Bianchi PP. Structured training and competence assessment in colorectal robotic surgery. Results of a consensus experts round table. Int J Med Robot 2016; 12:634-641. [DOI: 10.1002/rcs.1731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Wanda Petz
- European Institute of Oncology; Milan Italy
| | | | - Gyu Seog Choi
- Kyungpook National University Medical Centre; Daegu South Korea
| | | | - Cesar Santiago
- Centre for Robotic Surgery; St. Joseph Hospital; Tampa FL USA
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Kim KH, Shin SJ, Cho MS, Ahn JB, Jung M, Kim TI, Park YS, Kim H, Kim NK, Koom WS. A phase II study of preoperative mFOLFOX6 with short-course radiotherapy in patients with locally advanced rectal cancer and liver-only metastasis. Radiother Oncol 2015; 118:369-74. [PMID: 26705682 DOI: 10.1016/j.radonc.2015.11.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/23/2015] [Accepted: 11/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the efficacy and safety of upfront mFOLFOX6 followed by short-course radiotherapy (SCRT) and surgery in patients with locally advanced rectal cancer and liver-only metastases. MATERIALS AND METHODS This single-arm phase II study involved 32 patients. mFOLFOX6 was administered for four cycles followed by SCRT and another four cycles of mFOLFOX6. Surgery was performed 4-6 weeks after the last chemotherapy cycle. The primary endpoint was complete (R0) resection rate. Secondary endpoints were response rate, progression-free survival (PFS), overall survival (OS), and complication rates. RESULTS Surgical resection of the rectum and liver was performed in 25 patients (78%) and R0 resection was achieved in 20 patients (63%). Local tumor downstaging was observed in 54% of patients. Median OS and PFS were 38 and 9 months, respectively. One patient discontinued treatment due to toxicity and no treatment-related deaths occurred. Patients who progressed after 4 cycles of mFOLFOX6 were less likely to receive resection. CONCLUSIONS This regimen was safe and effective in inducing local tumor response and achieving R0 resection in this patient population.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Division of Colorectal Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Suk Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hoguen Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Wilder FG, Burnett A, Oliver J, Demyen MF, Chokshi RJ. A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer. Indian J Surg 2015; 78:214-9. [PMID: 27358517 DOI: 10.1007/s12262-015-1375-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/12/2015] [Indexed: 12/23/2022] Open
Abstract
The goal of this review was to compare long-term oncologic outcomes of robotic versus laparoscopic resection of colorectal cancer. A literature search was performed using PubMed, EMBASE, Cochrane, and Medline (2002-2014). Search terms: laparoscopic, robotic, rectal, colon, surgery, oncologic, and outcomes. Studies comparing overall and disease free survival of robotic versus laparoscopic surgery for colorectal cancer were included. Meta-analysis was performed using OpenMeta[Analyst] for Windows 8. Five studies were identified reporting on overall survival, disease free survival, lymph node extraction, and distal and circumferential resection margin. Three hundred and seventeen patients underwent robotic resection and 368 underwent laparoscopic resection, with similar demographics. Operative times were longer with robotic resections, with no difference in estimated blood loss (EBL) or length of stay. The disease stage was distributed similarly in both groups. Similar numbers underwent neo-adjuvant therapy. Laparoscopic resection was associated with 3.2 mm larger distal resection margins (p = 0.04) and 2.2 more lymph nodes removed (p = 0.001), but with equivalent circumferential resection margin status. Disease-free and overall survival was equivalent. Robotic and laparoscopic surgery for colorectal cancer offer comparable overall and disease free survival. Laparoscopic surgery offered a slight advantage in operative time, distal margin, and lymph node yield. Larger, prospective trials are needed to confirm the equivalence of these approaches.
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Affiliation(s)
- Fatima G Wilder
- Department of Surgery, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101 USA
| | - Atuhani Burnett
- Department of Surgery, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101 USA
| | - Joseph Oliver
- Department of Surgery, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101 USA
| | - Michael F Demyen
- Department of Medicine, Rutgers-New Jersey Medical School, 90 Bergen St, DOC 2100, Newark, NJ 07103 USA
| | - Ravi J Chokshi
- Rutgers-New Jersey Medical School, University Hospital Cancer Center, 205 South Orange Avenue, G-1228, Newark, NJ 07103 USA
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Kim NK, Kim YW, Cho MS. Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery. Surg Oncol 2015; 24:172-80. [PMID: 26141555 DOI: 10.1016/j.suronc.2015.06.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/14/2015] [Indexed: 02/08/2023]
Abstract
The primary goal of surgical intervention for rectal cancer is to achieve an oncologic cure while preserving function. Since the introduction of total mesorectal excision (TME), the oncologic outcome has improved greatly in terms of local recurrence and cancer-specific survival. However, there are still concerns regarding functional outcomes such as sexual and urinary dysfunction, even among experienced colorectal surgeons. Intraoperative nerve damage is the primary reason for sexual and urinary dysfunction and occurs due to lack of anatomical knowledge and poor visualization of the pelvic autonomic nerves. The rectum is located concavely along the curved sacrum and both the ischial tuberosity and iliac wing limit the pelvic cavity boundary. Thus, pelvic autonomic nerve preservation during dissection in a narrow or deep pelvis, with adherence to the TME principles, is very challenging for colorectal surgeons. Recent developments in robotic technology enable overcoming these difficulties caused by complex pelvic anatomy. This system can facilitate better preservation of the pelvic autonomic nerve and thereby achieve favorable postoperative sexual and voiding functions after rectal cancer surgery. The nerve-preserving TME technique includes identification and preservation of the superior hypogastric plexus nerve, bilateral hypogastric nerves, pelvic plexus, and neurovascular bundles. Standardized procedures should be performed sequentially as follows: posterior dissection, deep posterior dissection, anterior dissection, posterolateral dissection, and final circumferential pelvic dissection toward the pelvic floor. In future perspective, a structured education program on nerve-preserving robotic TME should be incorporated in the training for minimally invasive surgery.
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Affiliation(s)
- Nam Kyu Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Young Wan Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Min Soo Cho
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim CW, Baik SH, Roh YH, Kang J, Hur H, Min BS, Lee KY, Kim NK. Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: a propensity score-matching analysis. Medicine (Baltimore) 2015; 94:e823. [PMID: 26039115 PMCID: PMC4616367 DOI: 10.1097/md.0000000000000823] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although the total cost of robotic surgery (RS) is known to be higher than that of laparoscopic surgery (LS), the cost-effectiveness of RS has not yet been verified. The aim of the study is to clarify the cost-effectiveness of RS compared with LS for rectal cancer.From January 2007 through December 2011, 311 and 560 patients underwent totally RS and conventional LS for rectal cancer, respectively. A propensity score-matching analysis was performed with a ratio of 1:1 to reduce the possibility of selection bias. Costs and perioperative short-term outcomes in both the groups were compared. Additional costs due to readmission were also analyzed.The characteristics of the patients were not different between the 2 groups. Most perioperative outcomes were not different between the groups except for the operation time. Complications within 30 days of surgery were not significantly different. Total hospital charges and patients' bill were higher in RS than in LS. The total hospital charges for patients who recovered with or without complications were higher in RS than in LS, although their short-term outcomes were similar. In patients with complications, the postoperative course after RS appeared to be milder than that of LS. Total hospital charges for patients who were readmitted due to complications were similar between the groups.RS showed similar short-term outcomes with higher costs than LS. Therefore, cost-effectiveness focusing on short-term perioperative outcomes of RS was not demonstrated.
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Affiliation(s)
- Chang Woo Kim
- Division of Colon and Rectal Surgery (CWK, SHB, JK, HH, BSM, KYL, NKK), Department of Surgery, Severance Hospital; and Biostatistics Collaboration Unit (YHR), Yonsei University College of Medicine, Seoul, South Korea
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Robotic versus laparoscopic surgery for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of short-term outcomes. J Robot Surg 2015; 9:187-94. [PMID: 26531198 DOI: 10.1007/s11701-015-0514-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/07/2015] [Indexed: 02/01/2023]
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.
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Tam MS, Kaoutzanis C, Mullard AJ, Regenbogen SE, Franz MG, Hendren S, Krapohl G, Vandewarker JF, Lampman RM, Cleary RK. A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. Surg Endosc 2015; 30:455-463. [PMID: 25894448 DOI: 10.1007/s00464-015-4218-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current data addressing the role of robotic surgery for the management of colorectal disease are primarily from single-institution and case-matched comparative studies as well as administrative database analyses. The purpose of this study was to compare minimally invasive surgery outcomes using a large regional protocol-driven database devoted to surgical quality, improvement in patient outcomes, and cost-effectiveness. METHODS This is a retrospective cohort study from the prospectively collected Michigan Surgical Quality Collaborative registry designed to compare outcomes of patients who underwent elective laparoscopic, hand-assisted laparoscopic, and robotic colon and rectal operations between July 1, 2012 and October 7, 2014. We adjusted for differences in baseline covariates between cases with different surgical approaches using propensity score quintiles modeled on patient demographics, general health factors, diagnosis, and preoperative co-morbidities. The primary outcomes were conversion rates and hospital length of stay. Secondary outcomes included operative time, and postoperative morbidity and mortality. RESULTS A total of 2735 minimally invasive colorectal operations met inclusion criteria. Conversion rates were lower with robotic as compared to laparoscopic operations, and this was statistically significant for rectal resections (colon 9.0 vs. 16.9%, p < 0.06; rectum 7.8 vs. 21.2%, p < 0.001). The adjusted length of stay for robotic colon operations (4.00 days, 95% CI 3.63-4.40) was significantly shorter compared to laparoscopic (4.41 days, 95% CI 4.17-4.66; p = 0.04) and hand-assisted laparoscopic cases (4.44 days, 95% CI 4.13-4.78; p = 0.008). There were no significant differences in overall postoperative complications among groups. CONCLUSIONS When compared to conventional laparoscopy, the robotic platform is associated with significantly fewer conversions to open for rectal operations, and significantly shorter length of hospital stay for colon operations, without increasing overall postoperative morbidity. These findings and the recent upgrades in minimally invasive technology warrant continued evaluation of the role of the robotic platform in colorectal surgery.
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Affiliation(s)
- Michael S Tam
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA
| | - Christodoulos Kaoutzanis
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA
| | - Andrew J Mullard
- Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA
| | - Scott E Regenbogen
- Division of Colorectal Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael G Franz
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA
| | - Samantha Hendren
- Division of Colorectal Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Greta Krapohl
- Michigan Surgical Quality Collaborative, University of Michigan Health System, Ann Arbor, MI, USA
| | - James F Vandewarker
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA
| | - Richard M Lampman
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA
| | - Robert K Cleary
- Division of Colorectal Surgery, Department of Surgery, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 2111, Ann Arbor, MI, 48106, USA.
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Dhruva Rao PK, Nair MS, Haray PN. Feasibility and oncological outcomes of laparoscopic rectal resection following neo-adjuvant chemo-radiotherapy: A systematic review. World J Surg Proced 2015; 5:147-154. [DOI: 10.5412/wjsp.v5.i1.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 12/23/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the feasibility and oncological outcomes following laparoscopic total mesorectal excision (LTME) in patients who have received Neo-adjuvant long course chemo-radiotherapy (LCRT).
METHODS: A protocol driven systematic review of published literature was undertaken to assess the feasibility and oncological outcomes following LTME in patients receiving LCRT. The feasibility was assessed using peri-operative outcomes and short term results. The oncological outcomes were assessed using local recurrence, disease free survival and overall survival.
RESULTS: Only 8 studies-1 randomized controlled trial, 4 Case Matched/Controlled Studies and 3 Case Series were identified matching the search criteria. The conversion rate was low (1.2% to 28.1%), anastomotic leak rates were similar to open total mesorectal excision (0%-4.1% vs 0%-8.3%). Only 3 studies reported on local recurrence rates (5.2%-7.6%) at median 34 mo follow-up. A single study described disease free survival and overall survival at 3 years as 78.8% and 92.1% respectively.
CONCLUSION: LTME following LCRT is feasible in experienced hands, with acceptable short term surgical outcomes and with the usual benefits associated with minimally invasive procedures. The long term oncological outcomes of LTME after LCRT appear to be comparable to open procedures but need further investigation.
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