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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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2
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Wu H, Guo R, Li H. Short-term and long-term efficacy in robot-assisted treatment for mid and low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 39:7. [PMID: 38127156 PMCID: PMC10739549 DOI: 10.1007/s00384-023-04579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aims to conduct a meta-analysis to evaluate the short-term and long-term therapeutic effects of robot-assisted laparoscopic treatment in patients with mid and low rectal cancer. METHODS A comprehensive search strategy was employed to retrieve relevant literature from PubMed, NCBI, Medline, and Springer databases, spanning the database inception until August 2023. The focus of this systematic review was on controlled studies that compared the treatment outcomes of robot-assisted (Rob) and conventional laparoscopy (Lap) in the context of mid and low rectal cancer. Data extraction and literature review were meticulously conducted by two independent researchers (HMW and RKG). The synthesized data underwent rigorous analysis utilizing RevMan 5.4 software, adhering to established methodological standards in systematic reviews. The primary outcomes encompass perioperative outcomes and oncological outcomes. Secondary outcomes include long-term outcomes. RESULT A total of 11 studies involving 2239 patients with mid and low rectal cancer were included (3 RCTs and 8 NRCTs); the Rob group consisted of 1111 cases, while the Lap group included 1128 cases. The Rob group exhibited less intraoperative bleeding (MD = -40.01, 95% CI: -57.61 to -22.42, P < 0.00001), a lower conversion rate to open surgery (OR = 0.27, 95% CI: 0.09 to 0.82, P = 0.02), a higher number of harvested lymph nodes (MD = 1.97, 95% CI: 0.77 to 3.18, P = 0.001), and a lower CRM positive rate (OR = 0.46, 95% CI: 0.23 to 0.95, P = 0.04). Additionally, the Rob group had lower postoperative morbidity rate (OR = 0.66, 95% CI: 0.53 to 0.82, P < 0.0001) and a lower occurrence rate of complications with Clavien-Dindo grade ≥ 3 (OR = 0.60, 95% CI: 0.39 to 0.90, P = 0.02). Further subgroup analysis revealed a lower anastomotic leakage rate (OR = 0.66, 95% CI: 0.45 to 0.97, P = 0.04). No significant differences were observed between the two groups in the analysis of operation time (P = 0.42), occurrence rates of protective stoma (P = 0.81), PRM (P = 0.92), and DRM (P = 0.23), time to flatus (P = 0.18), time to liquid diet (P = 0.65), total hospital stay (P = 0.35), 3-year overall survival rate (P = 0.67), and 3-year disease-free survival rate (P = 0.42). CONCLUSION Robot-assisted laparoscopic treatment for mid and low rectal cancer yields favorable outcomes, demonstrating both efficacy and safety. In comparison to conventional laparoscopy, patients experience reduced intraoperative bleeding and a lower incidence of complications. Notably, the method achieves comparable short-term and long-term treatment results to those of conventional laparoscopic surgery, thus justifying its consideration for widespread clinical application.
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Affiliation(s)
- Huiming Wu
- Department of General Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Renkai Guo
- Department of General Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Huiyu Li
- Department of General Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, 030032, China.
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Calleja R, Medina-Fernández FJ, Vallejo-Lesmes A, Durán M, Torres-Tordera EM, Díaz-López CA, Briceño J. Transition from laparoscopic to robotic approach in rectal cancer: a single-center short-term analysis based on the learning curve. Updates Surg 2023; 75:2179-2189. [PMID: 37874533 DOI: 10.1007/s13304-023-01655-9] [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: 06/30/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
As a novel procedure becomes more and more used, knowledge about its learning curve and its impact on outcomes is useful for future implementations. Our aim is (i) to identify the phases of the robotic rectal surgery learning process and assess the safety and oncological outcomes during that period, (ii) to compare the robotic rectal surgery learning phases outcomes with laparoscopic rectal resections performed before the implementation of the robotic surgery program. We performed a retrospective study, based on a prospectively maintained database, with methodological quality assessment by STROBE checklist. All the procedures were performed by the same two surgeons. A total of 157 robotic rectal resections from June 2018 to January 2022 and 97 laparoscopic rectal resections from January 2018 to July 2019 were included. The learning phase was completed at case 26 for surgeon A, 36 for surgeon B, and 60 for the center (both A & B). There were no differences in histopathological results or postoperative complications between phases, achieving the same ratio of mesorectal quality, circumferential and distal resection margins as the laparoscopic approach. A transitory increase of major complications and anastomotic leakage could occur once overcoming the learning phase, secondary to the progressive complexity of cases. Robotic rectal cancer surgery learning curve phases in experienced laparoscopic surgeons was completed after 25-35 cases. Implementation of a robotic rectal surgery program is safe in oncologic terms, morbidity, mortality and length of stay.
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Affiliation(s)
- Rafael Calleja
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain.
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.
| | - Francisco Javier Medina-Fernández
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Ana Vallejo-Lesmes
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain
| | - Manuel Durán
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Eva M Torres-Tordera
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain
| | - César A Díaz-López
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Javier Briceño
- General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
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4
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Dulskas A, Caushaj PF, Grigoravicius D, Zheng L, Fortunato R, Nunoo-Mensah JW, Samalavicius NE. International Society of University Colon and Rectal Surgeons survey of surgeons' preference on rectal cancer treatment. Ann Coloproctol 2023; 39:307-314. [PMID: 36217808 PMCID: PMC10475796 DOI: 10.3393/ac.2022.00255.0036] [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: 04/09/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Rectal cancer treatment has a wide range of possible approaches from radical extirpative surgery to nonoperative watchful waiting following chemoradiotherapy, with or without, additional chemotherapy. Our goal was to assess the personal opinion of active practicing surgeons on rectal cancer treatment if he/she was the patient. METHODS A panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) selected 10 questions that were included in a questionnaire that included other items including demographics. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in our database and remained open from April 16 to 28, 2020. RESULTS One hundred sixty-three specialists completed the survey. The majority of surgeons (n=65, 39.9%) chose the minimally invasive (laparoscopic) surgery for their personal treatment of rectal cancer. For low-lying rectal cancer T1 and T2, the treatment choice was standard chemoradiation+local excision (n=60, 36.8%) followed by local excision±chemoradiotherapy if needed (n=55, 33.7%). In regards to locally advanced low rectal cancer T3 or greater, the preference of the responders was for laparoscopic surgery (n=65, 39.9%). We found a statistically significant relationship between surgeons' age and their preference for minimally invasive techniques demonstrating an age-based bias on senior surgeons' inclination toward open approach. CONCLUSION Our survey reveals an age-based preference by surgeons for minimally invasive surgical techniques as well as organ-preserving techniques for personal treatment of treating rectal cancer. Only 1/4 of specialists do adhere to the international guidelines for treating early rectal cancer.
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Affiliation(s)
- Audrius Dulskas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Philip F. Caushaj
- Department of Surgery, University of Connecticut School of Medicine and Hartford Hospital, Hartford, CT, USA
| | - Domas Grigoravicius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Liu Zheng
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Richard Fortunato
- Department of Colorectal Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Joseph W. Nunoo-Mensah
- Department of Colorectal Surgery, King’s College Hospital Foundation NHS Trust, London, UK
| | - Narimantas E. Samalavicius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Health Research and Innovation Science Centre Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
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5
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Flynn J, Larach JT, Kong JCH, Rahme J, Waters PS, Warrier SK, Heriot A. Operative and oncological outcomes after robotic rectal resection compared with laparoscopy: a systematic review and meta-analysis. ANZ J Surg 2023; 93:510-521. [PMID: 36214098 DOI: 10.1111/ans.18075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most studies comparing robotic and laparoscopic surgery, show little difference in clinical outcomes to justify the expense. We systematically reviewed and pooled evidence from studies comparing robotic and laparoscopic rectal resection. METHOD Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (EMBASE), and Cochrane databases were searched for studies between 1996 and 2021 comparing clinical outcomes between laparoscopic and robotic rectal surgeries involving total mesorectal excision. Outcome measures included operative times, conversions to open, complications, recurrence and survival rates. RESULTS Fifty eligible studies compared outcomes between robotic and laparoscopic rectal resections; three were randomized trials. Pooled results showed significantly longer operating times for robotic surgery but lower conversion and complications rates, shorter lengths of stay in hospital, better rates of complete mesorectal resection and better three-year overall survival. However, the low number of randomized studies makes most data subject to bias. CONCLUSION Available evidence supports the safety and ongoing use of robotic rectal cancer surgery, while further high-quality evidence is sought to justify the expense.
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Affiliation(s)
- Julie Flynn
- Department of Surgery, Epworth Healthcare, Richmond, Victoria, Australia
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of post graduate studies, University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jose T Larach
- Department of Surgery, Epworth Healthcare, Richmond, Victoria, Australia
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joseph C H Kong
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of post graduate studies, University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jessica Rahme
- Department of Surgery, Epworth Healthcare, Richmond, Victoria, Australia
- General Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Peadar S Waters
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Department of Surgery, Epworth Healthcare, Richmond, Victoria, Australia
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of post graduate studies, University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Department of Surgery, Epworth Healthcare, Richmond, Victoria, Australia
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of post graduate studies, University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Burghgraef TA, Sikkenk DJ, Crolla RMPH, Fahim M, Melenhorst J, Moumni ME, Schelling GVD, Smits AB, Stassen LPS, Verheijen PM, Consten ECJ. Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency. Int J Colorectal Dis 2023; 38:9. [PMID: 36630001 PMCID: PMC9834356 DOI: 10.1007/s00384-022-04303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision. METHODS A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. RESULTS In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve. CONCLUSION The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.
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Affiliation(s)
- T A Burghgraef
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
| | - D J Sikkenk
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - M Fahim
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - J Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M El Moumni
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - A B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L P S Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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7
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Zheng K, Hu Q, Yu G, Zhou L, Yao Y, Zhou Y, Wang H, Hao L, Yu E, Lou Z, Zhang Y, Qiu H, Meng R, Zhang W. Trends of sphincter-preserving surgeries for low lying rectal cancer: A 20-year experience in China. Front Oncol 2022; 12:996866. [PMID: 36568186 PMCID: PMC9773833 DOI: 10.3389/fonc.2022.996866] [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: 07/18/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background Over the last 2 decades, patients with low rectal cancer have had better outcomes from improvements in surgical techniques in sphincter preservation. We aimed to quantify the trends in sphincter-preserving surgeries for low rectal cancer over 20 years in a top tertiary hospital in China. Methods Between 1999 and 2021, a cohort of patients with primary malignant rectal tumor ≤5cm from the anal verge and who received elective surgeries at Changhai Hospital, Shanghai, China, was identified. Data were extracted from electronic medical records. A Joinpoint Regression Model was used to analyze trends in surgical procedures by average annual percentage change (AAPC). Adjusted Cox proportional hazards regression model was used to assess overall survival. Results Among a total of 4,172 patients during the study period, 3,111 (74.6%) underwent a sphincter-preserving surgery and 1,061 (25.4%) received APR. Sphincter-preserving surgery increased 3.6% per year (95%CI, 2.3-4.9). Low anterior resection was the most performed procedure (86.3%) and maintained a steady trend, while intersphincteric resection increased 49.4% annually (95%CI, 19.5-86.7) after initiation. Laparoscopic techniques increased 15.1% per year (95%CI, 8.4-43.4) after initiation. Sphincter-preserving surgery increased annually for tumors ≤2cm, 2-≤3cm and 3-≤4cm from the anal verge (AAPC 7.1, 4.5-9.8; 4.7, 3.1-6.3; 2.7, 1.7-3.6, respectively). Furthermore, patients with sphincter-preserving surgery had a better overall survival than abdominoperineal resection (APR) patients (adjusted HR 0.78, 95% CI, 0.65-0.93, p=.01). Conclusions Utilization of sphincter-preserving surgeries increased significantly over the last 20 years. Patients with low rectal cancer who underwent sphincter preservation had better survival than similar patients who underwent APR.
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Affiliation(s)
- Kuo Zheng
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Qingqing Hu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Guanyu Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Leqi Zhou
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Yuting Yao
- Department of Professional Education, Johnson & Johnson Medical (Shanghai) LTD, Shanghai, China
| | - Yuan Zhou
- Department of Professional Education, Johnson & Johnson Medical (Shanghai) LTD, Shanghai, China
| | - Hao Wang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Liqiang Hao
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Enda Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Zheng Lou
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Yongjing Zhang
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Hong Qiu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Ronggui Meng
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China,*Correspondence: Wei Zhang,
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Yamanashi T, Miura H, Tanaka T, Watanabe A, Yokoi K, Kojo K, Niihara M, Yamashita K, Sato T, Kumamoto Y, Hiki N, Naitoh T. Short-term outcomes of robot-assisted versus conventional laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiotherapy: a propensity score-matched analysis. J Robot Surg 2022; 17:959-969. [DOI: 10.1007/s11701-022-01498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
AbstractThe benefits of robot-assisted laparoscopic surgery (RALS) for rectal cancer remain controversial. Only a few studies have evaluated the safety and feasibility of RALS following neoadjuvant chemoradiotherapy (NCRT). This study aimed to compare the short-term outcomes of RALS versus conventional laparoscopic surgery (CLS) after NCRT for rectal cancer. Propensity score matching of 111 consecutive patients who underwent RALS or CLS after NCRT for rectal adenocarcinoma between February 2014 and February 2022 was performed. Among them, 60 matched patients were enrolled and their short-term outcomes were compared. Although operative time, conversion rate to open laparotomy and blood loss were comparable, the incidence of postoperative complications, including anastomotic leakage, was significantly lower, urinary retention tended to be lower, and the days to soft diet intake and postoperative hospital stay were significantly shorter in the RALS than the CLS group. No postoperative mortality was observed in either group, and there were no significant differences in terms of resection margins and number of lymph nodes dissected. RALS after NCRT for rectal cancer is safe and technically feasible, and has acceptable short-term outcomes. Further studies are required for validation of the long-term oncological outcomes.
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Nillahoot N, Pillai BM, Sharma B, Wilasrusmee C, Suthakorn J. Interactive 3D Force/Torque Parameter Acquisition and Correlation Identification during Primary Trocar Insertion in Laparoscopic Abdominal Surgery: 5 Cases. SENSORS (BASEL, SWITZERLAND) 2022; 22:8970. [PMID: 36433567 PMCID: PMC9698636 DOI: 10.3390/s22228970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Laparoscopic procedures have become indispensable in gastrointestinal surgery. As a minimally invasive process, it begins with primary trocar insertion. However, this step poses the threat of injuries to the gastrointestinal tract and blood vessels. As such, the comprehension of the insertion process is crucial to the development of robotic-assisted/automated surgeries. To sustain robotic development, this research aims to study the interactive force/torque (F/T) behavior between the trocar and the abdomen during the trocar insertion process. For force/torque (F/T) data acquisition, a trocar interfaced with a six-axis F/T sensor was used by surgeons for the insertion. The study was conducted during five abdominal hernia surgical cases in the Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. The real-time F/T data were further processed and analyzed. The fluctuation in the force/torque (F/T) parameter was significant, with peak force ranging from 16.83 N to 61.86 N and peak torque ranging from 0.552 Nm to 1.76 Nm. The force parameter was observed to positively correlate with procedural time, while torque was found to be negatively correlated. Although during the process a surgeon applied force and torque in multiple axes, for a robotic system, the push and turn motion in a single axis was observed to be sufficient. For minimal tissue damage in less procedural time, a system with low push force and high torque was observed to be advantageous. These understandings will eventually benefit the development of computer-assisted or robotics technology to improve the outcome of the primary trocar insertion procedure.
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Affiliation(s)
- Nantida Nillahoot
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Branesh M. Pillai
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Bibhu Sharma
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Chumpon Wilasrusmee
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
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10
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Yamanashi T, Miura H, Tanaka T, Watanabe A, Goto T, Yokoi K, Kojo K, Niihara M, Hosoda K, Kaizu T, Yamashita K, Sato T, Kumamoto Y, Hiki N, Naitoh T. Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer: A single-center retrospective cohort study. Asian J Endosc Surg 2022; 15:794-804. [PMID: 35707930 PMCID: PMC9796680 DOI: 10.1111/ases.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Whether rectal cancer surgery by robotic-assisted laparoscopic surgery provides beneficial advantages remains controversial. Although favorable outcomes in terms of the safety and technical feasibility of robotic-assisted laparoscopic surgery have been demonstrated for rectal cancer, long-term oncological outcomes for robotic-assisted laparoscopic surgery have only been examined in a few studies. This retrospective study of subjects who underwent robotic-assisted laparoscopic surgery evaluated short- and long-term outcomes of consecutive rectal cancer patients. METHODS Between November 2016 and January 2020, we analyzed the records of 62 consecutive patients who underwent robotic-assisted laparoscopic surgery for rectal adenocarcinoma without distant metastasis to evaluate short- and long-term outcomes. RESULTS Tumors were located in the lower or mid-rectum (88.7%) in most patients. The median operative time was 357 min. No patient received transfusions, and the median blood loss was 10.5 ml. Open laparotomy was not required in any patient. A Clavien-Dindo classification of all grades was observed in 12 patients (19.4%). Positive radial margin was not observed in any patient. Duration of median follow-up was 40.5 mo, while 3-y overall survival and 3-y relapse-free survival rates were 96.8% and 85.0%, respectively. The local recurrence rate was 3.4%. CONCLUSION Favorable short- and long-term outcomes demonstrated robotic-assisted laparoscopic surgery was safe and technically feasible for rectal cancer.
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Affiliation(s)
- Takahiro Yamanashi
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Hirohisa Miura
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Toshimichi Tanaka
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Akiko Watanabe
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Takuya Goto
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Keigo Yokoi
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Ken Kojo
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Kei Hosoda
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Takashi Kaizu
- Department of General, Pediatric and Hepatobiliary‐Pancreatic SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology Department of Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan
| | - Takeo Sato
- Research and Development Center for Medical Education, Department Clinical Skills EducationKitasato University School of MedicineSagamiharaJapan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepatobiliary‐Pancreatic SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Naoki Hiki
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
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11
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Yamanashi T, Miura H, Tanaka T, Watanabe A, Goto T, Yokoi K, Kojo K, Niihara M, Hosoda K, Kaizu T, Yamashita K, Sato T, Kumamoto Y, Hiki N, Naitoh T. Comparison of short-term outcomes of robotic-assisted and conventional laparoscopic surgery for rectal cancer: A propensity score-matched analysis. Asian J Endosc Surg 2022; 15:753-764. [PMID: 35555973 PMCID: PMC9790312 DOI: 10.1111/ases.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/06/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The advantages of robotic-assisted laparoscopic surgery (RALS) for rectal cancer remain controversial. This study clarified and compared the short-term outcomes of RALS for rectal cancer with those of conventional laparoscopic surgery (CLS). METHODS The records of 303 consecutive patients who underwent RALS or CLS for rectal adenocarcinoma between November 2016 and November 2021 were analyzed using propensity score-matched analysis. After matching, 188 patients were enrolled in our study to compare short-term outcomes, such as operative results, postoperative complications, and pathological findings, in each group. RESULTS After matching, baseline characteristics were comparable between groups. Although operative time in the RALS group was significantly longer than in the CLS group (p < 0.0001), the conversion rate to open laparotomy and the postoperative complication rate in the RALS group were significantly lower than in the CLS group (p = 0.0240 and p = 0.0109, respectively). Blood loss was comparable between groups. In the RALS group, postoperative hospital stay and days to soft diet were significantly shorter than those in the CLS group (p = 0.0464 and p < 0.0001, respectively). No postoperative mortality was observed in either group and significant differences were observed in resection margins and number of lymph nodes harvested. CONCLUSION Robotic-assisted laparoscopic surgery for rectal cancer was safe, technically feasible, and had acceptable short-term outcomes. Further studies are required to validate long-term oncological outcomes.
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Affiliation(s)
- Takahiro Yamanashi
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Hirohisa Miura
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Toshimichi Tanaka
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Akiko Watanabe
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Takuya Goto
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Keigo Yokoi
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Ken Kojo
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Kei Hosoda
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Takashi Kaizu
- Department of General, Pediatric and Hepatobiliary‐Pancreatic SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Department of Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan
| | - Takeo Sato
- Research and Development Center for Medical Education, Department Clinical Skills EducationKitasato University School of MedicineSagamiharaJapan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepatobiliary‐Pancreatic SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Naoki Hiki
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
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12
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Angehrn FV, Schneider R, Wilhelm A, Daume D, Koechlin L, Fourie L, von Flüe M, Kern B, Steinemann DC, Bolli M. Robotic versus laparoscopic low anterior resection following neoadjuvant chemoradiation therapy for stage II-III locally advanced rectal cancer: a single-centre cohort study. J Robot Surg 2022; 16:1133-1141. [PMID: 35000106 DOI: 10.1007/s11701-021-01351-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
Neoadjuvant chemo-radiotherapy (nCRT) of locally advanced rectal cancer is associated with challenging surgical treatment and increased postoperative morbidity. Robotic technology overcomes laparoscopy limitations by enlarged 3D view, improved anatomical transection accuracy, and physiologic tremor reduction. Patients with UICC stage II-III rectal cancer, consecutively referred to our institution between March 2015 and June 2020 (n = 102) were treated with robotic (Rob-G, n = 38) or laparoscopic (Lap-G, n = 64) low anterior resection (LAR) for total meso-rectal excision (TME) following highly standardized and successful nCRT treatment. Feasibility, conversion rates, stoma creation, morbidity and clinical/pathological outcome were comparatively analysed. Sex, age, BMI, ASA scores, cTN stages and tumour distance from dentate line were comparable in the two groups. Robotic resection was always feasible without conversion to open surgery, which was necessary in 11/64 (17%) Lap-G operations (p = 0.006). Primary or secondary stomata were created in 17/38 (45%) Rob-G and 52/64 (81%) Lap-G patients (p < 0.001). Major morbidity occurred in 7/38 (18.4%) Rob-G and 6/64 (9.3%) Lap-G patients (p = 0.225). Although median operation time was longer in Rob-G compared with Lap-G (376; IQR: 330-417 min vs. 300; IQR: 270-358 min; p < 0.001), the difference was not significant in patients (Rob-G, n = 6; Lap-G, n = 10) with ≥30 BMI (p = 0.106). Number of resected lymph nodes, ypTN staging and circumferential resection margins (CRM) were comparable. Resection was complete in 87% of Rob-G and 89% of Lap-G patients (p = 0.750). Robotic LAR is not inferior to laparoscopic LAR following nCRT. Larger, randomized studies are needed to confirm lower conversion in robotic, compared to laparoscopic resection.
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Affiliation(s)
- Fiorenzo V Angehrn
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.
| | - Romano Schneider
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Alexander Wilhelm
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Diana Daume
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Luca Koechlin
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Lana Fourie
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Markus von Flüe
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Beatrice Kern
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Daniel C Steinemann
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Martin Bolli
- Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
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13
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Clinical Safety and Effectiveness of Robotic-Assisted Surgery in Patients with Rectal Cancer: Real-World Experience over 8 Years of Multiple Institutions with High-Volume Robotic-Assisted Surgery. Cancers (Basel) 2022; 14:cancers14174175. [PMID: 36077712 PMCID: PMC9454525 DOI: 10.3390/cancers14174175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The aim of this retrospective observational study was to evaluate perioperative and short-term oncological outcomes of robotic-assisted rectal surgery (RRS) in hospitals with a high-volume of robotic-assisted surgeries. This study enrolled patients with rectal adenocarcinoma undergoing RRS from three high-volume institutions from December 2011 to June 2020. Compared with other studies, our results revealed the equivalent or superior perioperative and short-term oncological outcomes. Hence, RRS is an effective, safe, and feasible technique for patients with rectal cancers in high-volume hospitals. Abstract The perioperative and short-term oncological outcomes of robotic-assisted rectal surgery (RRS) are unclear. This retrospective observational study enrolled patients with rectal adenocarcinoma undergoing RRS from three high-volume institutions in Taiwan. Of the 605 enrolled patients, 301 (49.75%), 176 (29.09%), and 116 (19.17%) had lower, middle, and upper rectal cancers, respectively. Low anterior resection (377, 62.31%) was the most frequent surgical procedure. Intraoperative blood transfusion was performed in 10 patients (2%). The surgery was converted to an open one for one patient (0.2%), and ten (1.7%) patients underwent reoperation. The overall complication rate was 14.5%, including 3% from anastomosis leakage. No deaths occurred during surgery and within 30 days postoperatively. The positive rates of distal resection margin and circumferential resection margin were observed in 21 (3.5%) and 30 (5.0%) patients, respectively. The 5-year overall and disease-free survival rates for patients with stage I–III rectal cancer were 91.1% and 86.3%, respectively. This is the first multi-institutional study in Taiwan with 605 patients from three high-volume hospitals. The overall surgical and oncological outcomes were equivalent or superior to those estimated in other studies. Hence, RRS is an effective and safe technique for rectal resection in high-volume hospitals.
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14
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Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Yakkali S, Teresa Selvin S, Thomas S, Bikeyeva V, Abdullah A, Radivojevic A, Abu Jad AA, Ravanavena A, Balani P. Comparison of Non-Oncological Postoperative Outcomes Following Robotic and Laparoscopic Colorectal Resection for Colorectal Malignancy: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e27015. [PMID: 35989760 PMCID: PMC9386330 DOI: 10.7759/cureus.27015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
The objective of this systematic review and meta-analysis is to compare the postoperative outcomes of robotic and laparoscopic colorectal resection for colorectal malignancy. We performed a systematic review using a comprehensive search strategy on several electronic databases (PubMed, PubMed Central, Medline, and Google Scholar) in April 2022. Postoperative outcomes of robotic versus laparoscopic surgery for colorectal cancer were compared using 12 end points. Observational studies, randomized controlled trials, and nonrandomized clinical trials comparing robotic and laparoscopic resection for colorectal cancer were included. The statistical analysis was performed using the risk ratio (RR) for categorical variables and the standardized mean differences (SMD) for continuous variables. Sixteen studies involving 2,318 patients were included. The difference in length of hospital stay was significantly shorter with robotic access (SMD = -0.10, 95% CI = -0.19, -0.01, P = 0.04, I2 = 0%). Regarding intra-abdominal abscesses, the analysis showed an advantage in favor of the robotic group, but the result was not statically significant (RR = 0.54, 95% CI = 0.28, 1.05, P = 0.07, I2 = 0%). Mechanical obstruction was found to be higher in robotic group, favoring laparoscopic access, but was not significant (RR = 1.91, 95% CI = 0.95, 3.83, P = 0.07, I2 = 0%). There was no difference in time to pass flatus and consume a soft diet. The rates of anastomotic leakage, ileus, wound infection, readmission, mortality, and incisional hernias were similar with both approaches. Robotic surgery for colorectal cancer is associated with a shorter hospital stay, with no differences in mortality and postoperative morbidity.
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Affiliation(s)
- Chetna Ravindra
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Safina Ali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Salomi Paul
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shreyas Yakkali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sneha Teresa Selvin
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sonu Thomas
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Viktoriya Bikeyeva
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ahmed Abdullah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aleksandra Radivojevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anas A Abu Jad
- Behavioral Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anvesh Ravanavena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prachi Balani
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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15
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Warps AK, Saraste D, Westerterp M, Detering R, Sjövall A, Martling A, Dekker JWT, Tollenaar RAEM, Matthiessen P, Tanis PJ. National differences in implementation of minimally invasive surgery for colorectal cancer and the influence on short-term outcomes. Surg Endosc 2022; 36:5986-6001. [PMID: 35258664 PMCID: PMC9283170 DOI: 10.1007/s00464-021-08974-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/31/2021] [Indexed: 12/24/2022]
Abstract
Background The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new surgical techniques and the effect on postoperative outcomes are important for quality assurance, can show potential areas for country-specific improvement, and might be illustrative and supportive for similar implementation programs in other countries. Therefore, this study aimed to evaluate differences in patient selection, applied techniques, and results of minimal invasive surgery for colorectal cancer between the Netherlands and Sweden. Methods Patients who underwent elective minimally invasive surgery for T1-3 colon or rectal cancer (2012–2018) registered in the Dutch ColoRectal Audit or Swedish ColoRectal Cancer Registry were included. Time trends in the application of MIS were determined. Outcomes were compared for time periods with a similar level of MIS implementation (Netherlands 2012–2013 versus Sweden 2017–2018). Multilevel analyses were performed to identify factors associated with adverse short-term outcomes. Results A total of 46,095 Dutch and 8,819 Swedish patients undergoing MIS for colorectal cancer were included. In Sweden, MIS implementation was approximately 5 years later than in the Netherlands, with more robotic surgery and lower volumes per hospital. Although conversion rates were higher in Sweden, oncological and surgical outcomes were comparable. MIS in the Netherlands for the years 2012–2013 resulted in a higher reoperation rate for colon cancer and a higher readmission rate but lower non-surgical complication rates for rectal cancer if compared with MIS in Sweden during 2017–2018. Conclusion This study showed that the implementation of MIS for colorectal cancer occurred later in Sweden than the Netherlands, with comparable outcomes despite lower volumes. Our study demonstrates that new surgical techniques can be implemented at a national level in a controlled and safe way, with thorough quality assurance. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08974-1.
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Affiliation(s)
- A K Warps
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands
| | - D Saraste
- Department of Surgery, Södersjukhuset, 118 83, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden
| | - M Westerterp
- Department of Surgery, Haagland Medisch Centrum, Lijnbaan 32, 2512 VA, Den Haag, Netherlands
| | - R Detering
- Department of Surgery, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - A Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden.,Department of Surgery, Karolinska University Hospital, Anna Steckséns gata 53, 171 64, Solna, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Insitutet, 171 76, Stockholm, Sweden.,Department of Surgery, Karolinska University Hospital, Anna Steckséns gata 53, 171 64, Solna, Sweden
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625 AD, Delft, Netherlands
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands
| | - P Matthiessen
- Department of Surgery, Örebro University Hospital, von Rosens väg 1, 70185, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, 70182, Örebro, Sweden
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centres, University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
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16
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Lam J, Tam MS, Retting RL, McLemore EC. Robotic Versus Laparoscopic Surgery for Rectal Cancer: A Comprehensive Review of Oncological Outcomes. Perm J 2021; 25. [PMID: 35348098 DOI: 10.7812/tpp/21.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
The treatment of rectal cancer is complex and involves specialized multidisciplinary care, although the tenet is still rooted in a high-quality total mesorectal excision. The robotic platform is one of many tools in the arsenal to assist dissection in the low pelvis. This article is a comprehensive review of the oncological outcome comparing robotic vs laparoscopic rectal cancer resection, with a particular focus on total mesorectal excision. There is no statistical difference in total mesorectal grade, circumferential margin, distal margin, and lymph node harvest. Survival data are less mature, but there is also no difference in disease-free or overall survival between the two techniques. Although additional randomized trials are still needed to validate these findings, both techniques are currently acceptable in the minimally invasive treatment of rectal cancer, and surgeon preference is paramount to safe and optimal resection.
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Affiliation(s)
- Jessica Lam
- Department of Surgery, Kaiser Permanente Riverside Medical Center, Riverside, CA
| | - Michael S Tam
- Department of Surgery, Kaiser Permanente Riverside Medical Center, Riverside, CA
| | - R Luke Retting
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Elisabeth C McLemore
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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17
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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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18
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Short-term outcomes of robotic-assisted versus conventional laparoscopic-assisted surgery for rectal cancer: a propensity score-matched analysis. J Robot Surg 2021; 16:323-331. [PMID: 33886065 DOI: 10.1007/s11701-021-01243-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/17/2021] [Indexed: 01/02/2023]
Abstract
It remains controversial whether the advantages of robotic-assisted surgery are beneficial for rectal cancer (RC). The study aimed to evaluate the short-term outcomes of robotic-assisted rectal surgery (RARS) compared with those of conventional laparoscopic-assisted rectal surgery. We retrospectively analyzed 539 consecutive patients with stage I-IV RC who had undergone elective surgery between January 2010 and December 2020, using propensity score-matched analysis. After propensity score matching, we enrolled 200 patients (n = 100 in each groups). Before matching, significant group-dependent differences were observed in terms of age (p = 0.04) and body mass index (p < 0.01). After matching, clinicopathologic outcomes were similar between the groups, but estimated operative time was longer and postoperative lymphorrhea was more frequent in the RARS group. Estimated blood loss, rate of conversion to laparotomy, and incidence of anastomotic leakage or reoperation were significantly lower in the RARS group. No surgical mortality was observed in either group. No significant differences were observed in terms of positive resection margins or number of lymph nodes harvested. RARS was safe and technically feasible, and achieved acceptable short-term outcomes. The robotic technique showed some advantages in RC surgery that require validation in further studies.
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19
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Asklid D, Ljungqvist O, Xu Y, Gustafsson UO. Short-term outcome in robotic vs laparoscopic and open rectal tumor surgery within an ERAS protocol: a retrospective cohort study from the Swedish ERAS database. Surg Endosc 2021; 36:2006-2017. [PMID: 33856528 PMCID: PMC8847168 DOI: 10.1007/s00464-021-08486-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Advantages of robotic technique over laparoscopic technique in rectal tumor surgery have yet to be proven. Large multicenter, register-based cohort studies within an optimized perioperative care protocol are lacking. The aim of this retrospective cohort study was to compare short-term outcomes in robotic, laparoscopic and open rectal tumor resections, while also determining compliance to the enhanced recovery after surgery (ERAS)®Society Guidelines. METHODS All patients scheduled for rectal tumor resection and consecutively recorded in the Swedish part of the international ERAS® Interactive Audit System between January 1, 2010 to February 27, 2020, were included (N = 3125). Primary outcomes were postoperative complications and length of stay (LOS) and secondary outcomes compliance to the ERAS protocol, conversion to open surgery, symptoms delaying discharge and reoperations. Uni- and multivariate comparisons were used. RESULTS Robotic surgery (N = 827) had a similar rate of postoperative complications (Clavien-Dindo grades 1-5), 35.9% compared to open surgery (N = 1429) 40.9% (OR 1.15, 95% CI (0.93, 1.41)) and laparoscopic surgery (N = 869) 31.2% (OR 0.88, 95% CI (0.71, 1.08)). LOS was longer in the open group, median 9 days (IRR 1.35, 95% CI (1.27, 1.44)) and laparoscopic group, 7 days (IRR 1.14, 95% CI (1.07, 1.21)) compared to the robotic group, 6 days. Pre- and intraoperative compliance to the ERAS protocol were similar between groups. CONCLUSIONS In this multicenter cohort study, robotic surgery was associated with shorter LOS compared to both laparoscopic and open surgery and had lower conversion rates vs laparoscopic surgery. The rate of complications was similar between groups.
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Affiliation(s)
- Daniel Asklid
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Danderyd, Sweden.
| | - Olle Ljungqvist
- Department of Surgery, Örebro & Institute of Molecular Medicine and Surgery, Örebro University and University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Yin Xu
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ulf O Gustafsson
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Danderyd, Sweden
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20
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Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases. J Robot Surg 2021; 16:179-187. [PMID: 33743145 DOI: 10.1007/s11701-021-01227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Robotic-assisted laparoscopic surgery attempts to facilitate rectal surgery in the narrow space of the pelvis. The aim of this study is to compare the outcomes of robotic versus laparoscopic surgery for rectal cancer. Monocentric retrospective study including 300 patients who underwent robotic (n = 178) or laparoscopic (n = 122) resection between Jan 2009 and Dec 2017 for high, mid and low rectal cancer. The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, except for sex and ASA status. There were no statistical differences between groups in the conversion rate to open surgery. Surgical morbidity and oncological quality did not differ in either group, except for the anastomosis leakage rate and the affected distal resection margin. There were no differences in overall survival rate between the laparoscopic and robotic group. Robotic surgery could provide some advantages over conventional laparoscopic surgery, such as three-dimensional views, articulated instruments, lower fatigue, lower conversion rate to open surgery, shorter hospital stays and lower urinary and sexual dysfunctions. On the other hand, robotic surgery usually implies longer operation times and higher costs. As shown in the ROLARR trial, no statistical differences in conversion rate were found between the groups in our study. When performed by experienced surgeons, robotic surgery for rectal cancer could be a safe and feasible option with no significant differences in terms of oncological outcomes in comparison to laparoscopic surgery.
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21
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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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22
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Oshio H, Oshima Y, Yunome G, Yano M, Okazaki S, Ashitomi Y, Musha H, Kamio Y, Motoi F. Potential urinary function benefits of initial robotic surgery for rectal cancer in the introductory phase. J Robot Surg 2021; 16:159-168. [PMID: 33723792 PMCID: PMC8863720 DOI: 10.1007/s11701-021-01216-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/20/2021] [Indexed: 12/24/2022]
Abstract
We aimed to evaluate the advantages and disadvantages of initial robotic surgery for rectal cancer in the introduction phase. This study retrospectively evaluated patients who underwent initial robotic surgery (n = 36) vs. patients who underwent conventional laparoscopic surgery (n = 95) for rectal cancer. We compared the clinical and pathological characteristics of patients using a propensity score analysis and clarified short-term outcomes, urinary function, and sexual function at the time of robotic surgery introduction. The mean surgical duration was longer in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (288.4 vs. 245.2 min, respectively; p = 0.051). With lateral pelvic lymph node dissection, no significant difference was observed in surgical duration (508.0 min for robot-assisted laparoscopy vs. 480.4 min for conventional laparoscopy; p = 0.595). The length of postoperative hospital stay was significantly shorter in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (15 days vs. 13.0 days, respectively; p = 0.026). Conversion to open surgery was not necessary in either group. The International Prostate Symptom Score was significantly lower in the robot-assisted laparoscopy group compared with the conventional laparoscopy group. Moderate-to-severe symptoms were more frequently observed in the conventional laparoscopy group compared with the robot-assisted laparoscopy group (p = 0.051). Robotic surgery is safe and could improve functional disorder after rectal cancer surgery in the introduction phase. This may depend on the surgeon’s experience in performing robotic surgery and strictly confined criteria in Japan.
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Affiliation(s)
- Hiroshi Oshio
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan.,Department of Surgery, Sendai Medical Center, 2-11-12 Miyagino, Miyagino-ku, Sendai, Miyagi-ken, 983-8520, Japan
| | - Yukiko Oshima
- Department of Surgery, Sendai Medical Center, 2-11-12 Miyagino, Miyagino-ku, Sendai, Miyagi-ken, 983-8520, Japan
| | - Gen Yunome
- Department of Surgery, Sendai Medical Center, 2-11-12 Miyagino, Miyagino-ku, Sendai, Miyagi-ken, 983-8520, Japan
| | - Mitsuyasu Yano
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan
| | - Shinji Okazaki
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan
| | - Yuya Ashitomi
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan
| | - Hiroaki Musha
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan
| | - Yukinori Kamio
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan
| | - Fuyuhiko Motoi
- Department of First Surgery, Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata-ken, 990-9585, Japan.
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23
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Gall TMH, Alrawashdeh W, Soomro N, White S, Jiao LR. Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves. BJS Open 2020; 4:1100-1108. [PMID: 33052038 PMCID: PMC7709379 DOI: 10.1002/bjs5.50353] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Minimally invasive surgery is the standard technique for many operations. Laparoscopic training has a long learning curve. Robotic solutions may shorten the training pathway. The aim of this study was to compare laparoscopic with robotic training in surgical trainees and medical students. METHODS Surgical trainees (ST group) were randomized to receive 6 h of robotic or laparoscopic simulation training. They then performed three surgical tasks in cadaveric specimens. Medical students (MS group) had 2 h of robotic or laparoscopic simulation training followed by one surgical task. The Global Rating Scale (GRS) score (maximum 30), number of suture errors, and time to complete each procedure were recorded. RESULTS The median GRS score for the ST group was better for each procedure after robotic training compared with laparoscopic training (total GRS score: 27·00 (i.q.r. 22·25-28·33) versus 18·00 (16·50-19·04) respectively, P < 0·001; 10 participants in each arm). The ST group made fewer errors in robotic than in laparoscopic tasks, for both continuous (7·00 (4·75-9·63) versus 22·25 (20·75-25·25); P < 0·001) and interrupted (8·25 (6·38-10·13) versus 29·50 (23·75-31·50); P < 0·001) sutures. For the MS group, the robotic group completed 8·67 interrupted sutures with 15·50 errors in 40 min, compared with only 3·50 sutures with 40·00 errors in the laparoscopic group (P < 0·001) (10 participants in each arm). Fatigue and physical comfort levels were better after robotic compared with laparoscopic operating for both groups (P < 0·001). CONCLUSION The acquisition of surgical skills in surgical trainees and the surgically naive takes less time with a robotic compared with a laparoscopic platform.
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Affiliation(s)
- T. M. H. Gall
- The Academic Surgical UnitThe Royal Marsden Hospital, Imperial CollegeLondonUK
| | - W. Alrawashdeh
- Hepatopancreatobiliary Surgical UnitNewcastle upon TyneUK
| | - N. Soomro
- Department of UrologyThe Freeman HospitalNewcastle upon TyneUK
| | - S. White
- Hepatopancreatobiliary Surgical UnitNewcastle upon TyneUK
| | - L. R. Jiao
- The Academic Surgical UnitThe Royal Marsden Hospital, Imperial CollegeLondonUK
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24
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Xu J, Tang B, Li T, Jia B, Yao H, Zhao R, Yuan W, Zhong M, Chi P, Zhou Y, Yang X, Cheng L, He Y, Li Y, Tong W, Sun X, Jiang Z, Wang K, Li X, Wang X, Wei Y, Chen Z, Zhang X, Ye Y, Han F, Tao K, Kong D, Wang Z, Zhang C, He G, Feng Q. Robotic colorectal cancer surgery in China: a nationwide retrospective observational study. Surg Endosc 2020; 35:6591-6603. [PMID: 33237468 DOI: 10.1007/s00464-020-08157-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Robotic colorectal cancer surgery is widely accepted and applied. However, there is still no objective and comprehensive assessment on the data of nationwide multicenter series. METHOD A total of 28 medical centers in Mainland China participated in this nationwide retrospective observational study. From the first case performed in each center to the last until December 2017, patients with robotic resection for primary tumor and pathologically confirmed colorectal adenocarcinoma were consecutively enrolled. Clinical, pathological and follow-up data were collected and analyzed. RESULTS A total of 5389 eligible patients were finally enrolled in this study, composing 72.2% of the total robotic colorectal surgery volume of Mainland China in the same period. For resections of one bowel segment of primary tumor, the postoperative mortality rate was 0.08% (4/5063 cases), and the postoperative complication rate (Clavien-Dindo grade II or higher) was 8.6% (434/5063 cases). For multiple resections, the postoperative mortality rate was 0.6% (2/326 cases), and the postoperative complication rate was 16.3% (53/326 cases). Out of 2956 patients receiving sphincter-preserving surgery in only primary resection, 130 (4.4%) patients had anastomotic leakage. Traditional low anterior resection (tumor at middle rectum) (OR 2.384, P < 0.001), traditional low anterior resection (tumor at low rectum) (OR 1.968, P = 0.017) and intersphincteric resection (OR 5.468, P = 0.006) were significant independent risk factors for anastomotic leakage. Female gender (OR 0.557, P = 0.005), age ≥ 60 years (OR 0.684, P = 0.040), and preventive stoma (OR 0.496, P = 0.043) were significant independent protective factors. Body mass index, preoperative chemotherapy/radiotherapy, tumor size, and TNM stage did not independently affect the occurrence of anastomotic leakage. CONCLUSION Robotic colorectal cancer surgery was safe and reliable and might have advantages in patients at high risk of anastomotic leakage.
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Affiliation(s)
- Jianmin Xu
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
| | - Bo Tang
- The First Hospital Affiliated to Army Medical University (Southwest Hospital), Chongqing, People's Republic of China
| | - Taiyuan Li
- The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Baoqing Jia
- Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongliang Yao
- The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Ren Zhao
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Weitang Yuan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ming Zhong
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Pan Chi
- Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Yanbing Zhou
- The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xiongfei Yang
- Gansu Provincial People's Hospital, Lanzhou, People's Republic of China
| | - Longwei Cheng
- Jilin Cancer Hospital, Changchun, People's Republic of China
| | - Yulong He
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yongxiang Li
- The First Affiliated Hospital of Anhui Medical College, Hefei, People's Republic of China
| | - Weidong Tong
- Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xuejun Sun
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Zhiwei Jiang
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, People's Republic of China
| | - Kang Wang
- Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - Xiaorong Li
- The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Xin Wang
- Peking University First Hospital, Beijing, People's Republic of China
| | - Ye Wei
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zongyou Chen
- Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaoqiao Zhang
- The 960th Hospital of the PLA Joint Logistic Support Force (former Jinan Military General Hospital), Jinan, People's Republic of China
| | - Yingjiang Ye
- Peking University People's Hospital, Beijing, People's Republic of China
| | - Fanghai Han
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Kaixiong Tao
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Dalu Kong
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China
| | - Ziqiang Wang
- West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Cheng Zhang
- The General Hospital of Northern Theater Command (former the General Hospital of Shenyang Military), Shenyang, People's Republic of China
| | - Guodong He
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qingyang Feng
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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25
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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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26
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Impact of robotic learning curve on histopathology in rectal cancer: A pooled analysis. Surg Oncol 2020; 34:121-125. [PMID: 32891316 DOI: 10.1016/j.suronc.2020.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/10/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND A beneficial impact of robotic proctectomy on circumferential resection margin (CRM) is expected due to the robot's articulating instruments in the pelvis. There are however concerns about a negative impact on the quality of total mesorectal excision (TME) due to the lack of tactile feedback. The aim of this study was to assess whether surgeons' learning curve impacted CRM and TME quality. METHODS In a multicenter study, individual patient data of robotic proctectomy for resectable rectal cancer were pooled. Patients were stratified into two phases of surgeons' learning curve. Cumulative sum (CUSUM) analysis was used to determine the transition from learning phase (LP) to plateau phase (PP), which were compared. CRM was microscopically measured in mm by pathologists. TME quality was classified by pathologists as complete, nearly complete or incomplete. T-test and Chi-squared tests were used to compare continuous and categorical variables, respectively. RESULTS 235 patients underwent robotic proctectomy by five surgeons. 83 LP patients were comparable to 152 PP patients for age (p = 0.20), gender (67.5% vs. 65.1% males; p = 0.72), BMI (p = 0.82), cancer stage (p = 0.36), neoadjuvant chemoradiation (p = 0.13), distance of tumor from anal verge (5.8 ± 4.4 vs. 5.5 ± 3.3; p = 0.56). CRM did not differ (7.7 ± 11.4 mm vs. 8.4 ± 10.3 mm; p = 0.62). The rate of complete TME quality was significantly improved in PP patients as compared to LP patients (73.5% vs. 92.1%; p < 0.001). CONCLUSION While learning had no impact on circumferential resection margins, the quality of TME significantly improved during surgeons' plateau phase as compared to their learning phase.
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27
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Chen YT, Huang CW, Ma CJ, Tsai HL, Yeh YS, Su WC, Chai CY, Wang JY. An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis. BMC Surg 2020; 20:23. [PMID: 32013990 PMCID: PMC6998335 DOI: 10.1186/s12893-020-0687-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation. METHODS This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months. RESULTS Upon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS. CONCLUSIONS This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.
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Affiliation(s)
- Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 807, 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, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Division of General and Digestive 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, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Division of Trauma and Surgical Critical Care, 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, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen 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, No. 100 Tzyou 1st Road, Kaohsiung, 807, 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. .,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Katsuno H, Hanai T, Masumori K, Koide Y, Ashida K, Matsuoka H, Tajima Y, Endo T, Mizuno M, Cheong Y, Maeda K, Uyama I. Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:14-24. [PMID: 32002472 PMCID: PMC6989125 DOI: 10.23922/jarc.2019-037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Robotic surgery has the potential to overcome some limitations of laparoscopic surgery, especially in the narrow pelvis, providing a three-dimensional view, articulated instruments, and a stable camera platform. Although meta-analyses and randomized controlled trials have failed to demonstrate the superiority of robotic surgery over laparoscopic surgery with respect to the short-term clinical outcomes, the published findings suggest that robotic surgery may be potentially beneficial for patients who are obese, male, or patients undergoing sphincter-preserving surgery for rectal cancer. The safety and feasibility of robotic surgery for lateral lymph node dissection, the standard procedure for locally advanced lower rectal cancer in Japan, have been demonstrated in some retrospective studies. However, additional prospective, randomized trials are required to determine the actual benefits of robotic surgery to ameliorate the urogenital and oncological outcomes. The cost of this approach is a long-standing principal concern. A literature search showed that the cost of robotic surgery for rectal cancer was 1.3-2.5 times higher per patient than that for the laparoscopic approach. We herein describe our surgical technique using a da Vinci Surgical System (S/Si/Xi) with 10 years of experience in performing robotic surgery. We also review current evidence regarding short-term clinical and long-term oncological outcomes, lateral lymph node dissection, and the cost of the procedure.
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Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Keigo Ashida
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Masahiro Mizuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yeongcheol Cheong
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
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Lee JL, Alsaleem HA, Kim JC. Robotic surgery for colorectal disease: review of current port placement and future perspectives. Ann Surg Treat Res 2019; 98:31-43. [PMID: 31909048 PMCID: PMC6940430 DOI: 10.4174/astr.2020.98.1.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023] Open
Abstract
Purpose As robotic surgery is increasingly performed in patients with colorectal diseases, understanding proper port placement for robotic colorectal surgery is necessary. This review summarizes current port placement during robotic surgery for colorectal diseases and provides future perspective on port placements. Methods PubMed were searched from January 2009 to December 2018 using a combination of the search terms “robotic” [MeSH], “colon” [MeSH], “rectum” [MeSH], “colorectal” [MeSH], and “colorectal surgery” [MeSH]. Studies related to port placement were identified and included in the current study if they used the da Vinci S, Si, or Xi robotic system and if they described port placement. Results This review included 77 studies including a total of 3,145 operations. Fifty studies described port placement for left-sided and mesorectal excision; 17, 3, and 7 studies assessed port placement for right-sided colectomy, rectopexy, transanal surgery, respectively; and one study assessed surgery with reduced port placement. Recent literatures show that the single-docking technique included mobilization of the second and third robotic arms for the different parts without movement of patient cart and similar to previous dual or triple-docking technique. Besides, use of the da Vinci Xi system allowed a more simplified port configuration. Conclusion Robot-assisted colorectal surgery can be efficiently achieved with successful port placement without movement of patient cart dependent on the type of surgery and the robotic system.
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Affiliation(s)
- Jong Lyul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hassan A Alsaleem
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ng KT, Tsia AKV, Chong VYL. Robotic Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. World J Surg 2019; 43:1146-1161. [PMID: 30610272 DOI: 10.1007/s00268-018-04896-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery has been considered as an alternative to open surgery by surgeons for colorectal cancer. However, the efficacy and safety profiles of robotic and conventional laparoscopic surgery for colorectal cancer remain unclear in the literature. The primary aim of this review was to determine whether robotic-assisted laparoscopic surgery (RAS) has better clinical outcomes for colorectal cancer patients than conventional laparoscopic surgery (CLS). METHODS All randomized clinical trials (RCTs) and observational studies were systematically searched in the databases of CENTRAL, EMBASE and PubMed from their inception until January 2018. Case reports, case series and non-systematic reviews were excluded. RESULTS Seventy-three studies (6 RCTs and 67 observational studies) were eligible (n = 169,236) for inclusion in the data synthesis. In comparison with the CLS arm, RAS cohort was associated with a significant reduction in the incidence of conversion to open surgery (ρ < 0.001, I2 = 65%; REM: OR 0.40; 95% CI 0.30,0.53), all-cause mortality (ρ < 0.001, I2 = 7%; FEM: OR 0.48; 95% CI 0.36,0.64) and wound infection (ρ < 0.001, I2 = 0%; FEM: OR 1.24; 95% CI 1.11,1.39). Patients who received RAS had a significantly shorter duration of hospitalization (ρ < 0.001, I2 = 94%; REM: MD - 0.77; 95% CI 1.12, - 0.41; day), time to oral diet (ρ < 0.001, I2 = 60%; REM: MD - 0.43; 95% CI - 0.64, - 0.21; day) and lesser intraoperative blood loss (ρ = 0.01, I2 = 88%; REM: MD - 18.05; 95% CI - 32.24, - 3.85; ml). However, RAS cohort was noted to require a significant longer duration of operative time (ρ < 0.001, I2 = 93%; REM: MD 38.19; 95% CI 28.78,47.60; min). CONCLUSIONS This meta-analysis suggests that RAS provides better clinical outcomes for colorectal cancer patients as compared to the CLS at the expense of longer duration of operative time. However, the inconclusive trial sequential analysis and an overall low level of evidence in this review warrant future adequately powered RCTs to draw firm conclusion.
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Affiliation(s)
- Ka Ting Ng
- Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia.
| | - Azlan Kok Vui Tsia
- Department of Surgery, International Medical University, Bukit Jalil, 50603, Kuala Lumpur, Malaysia
| | - Vanessa Yu Ling Chong
- Department of Surgery, International Medical University, Bukit Jalil, 50603, Kuala Lumpur, Malaysia
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Oldani A, Cesana G, Uccelli M, Ciccarese F, Giorgi R, De Carli SM, Villa R, Olmi S. Surgical Outcomes of Rectal Resection: Our 10 Years Experience. J Laparoendosc Adv Surg Tech A 2019; 29:820-825. [PMID: 30676247 DOI: 10.1089/lap.2018.0731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Colorectal cancer, one of the most common tumor- and cancer-related deaths worldwide, requires a multidisciplinary management including neoadjuvant chemoradiotherapy and surgery. Laparoscopic surgery for rectal cancer is gaining popularity due to its safety profile and good oncological results, if performed by experienced surgeons in specialized centers. This study describes our 10 years experience in minimally invasive rectal cancer surgery. Methods: We have retrospectively evaluated a series of 140 patients treated with laparoscopic approach for rectal malignant and benign diseases. Results: A total of 134 patients (95.7%) underwent anterior rectal resection, in the remaining 6 cases (4.3%) abdominoperineal amputation was performed. All but 13 cases have been treated with laparoscopic approach, with conversion rate of 5.7%. Postoperative morbidity rate was 8.6% (2 cases of peritoneal bleeding and 10 cases of anastomotic fistulae; in 2 cases, fistula occurred in patients previously treated with chemoradiation). Conclusions: Conventional laparoscopy can provide adequate oncological outcomes even in patients with advanced rectal cancer, with advantages in terms of postoperative hospital stay, recovery time, acceptable operative time, and low complication and conversion rates.
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Affiliation(s)
- Alberto Oldani
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Giovanni Cesana
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Matteo Uccelli
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Francesca Ciccarese
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Riccardo Giorgi
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Stefano M De Carli
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Roberta Villa
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Stefano Olmi
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
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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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Ioannidis A, Machairas N, Koutserimpas C, Spartalis E, Konstantinidis M, Konstantinidis K. Evolution of robot-assisted general surgery in Greece and Cyprus. J Robot Surg 2018; 13:315-317. [DOI: 10.1007/s11701-018-00901-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
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Huang YM, Huang YJ, Wei PL. Colorectal Cancer Surgery Using the Da Vinci Xi and Si Systems: Comparison of Perioperative Outcomes. Surg Innov 2018; 26:192-200. [DOI: 10.1177/1553350618816788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose. Robotic surgery for colorectal cancer is an emerging technique. Potential benefits as compared with the conventional laparoscopic surgery have been demonstrated. However, experience with the previous da Vinci Si robotic system revealed several unsolved problems. The novel features of the new da Vinci Xi increase operational flexibility and maneuverability and are expected to facilitate the performance of multiquadrant surgery. Methods. Between December 2011 and May 2015, 120 patients with colon or rectal cancer were operated on using the Si robotic system (the Si group). Between May 2015 and October 2017, 60 more patients with colon or rectal cancer were operated on using the Xi robotic system (the Xi group). The clinicopathological characteristics and perioperative outcomes of these 2 groups of patients were compared. Results. The 2 groups of patients were comparable with regard to baseline clinical characteristics, types of resection performed, and the proportion of patients undergoing neoadjuvant chemoradiation therapy. The statuses of resection margin, the numbers of lymph nodes harvested, and the rates of postoperative complications were also similar between the 2 groups. Nevertheless, a lower rate of diverting ileostomy, a shorter operation time, less estimated blood loss, and a faster postoperative recovery was observed in the Xi group. Conclusions. Colorectal cancer surgery using the Xi robotic system was associated with improved perioperative outcomes. These benefits may be attributed to its improved, more user-friendly design.
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Affiliation(s)
- Yu-Min Huang
- Taipei Medical University, Taiwan
- Taipei Medical University Hospital, Taiwan
| | - Yan Jiun Huang
- Taipei Medical University, Taiwan
- Taipei Medical University Hospital, Taiwan
| | - Po-Li Wei
- Taipei Medical University, Taiwan
- Taipei Medical University Hospital, Taiwan
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Aselmann H, Kersebaum JN, Bernsmeier A, Beckmann JH, Möller T, Egberts JH, Schafmayer C, Röcken C, Becker T. Robotic-assisted total mesorectal excision (TME) for rectal cancer results in a significantly higher quality of TME specimen compared to the laparoscopic approach-report of a single-center experience. Int J Colorectal Dis 2018; 33:1575-1581. [PMID: 29971488 DOI: 10.1007/s00384-018-3111-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
Abstract
AIM Robotic surgery allows for a better visualization and more precise dissection especially in the narrow male pelvis and mid and lower third of the rectum. However, superiority to laparoscopic TME has yet to be proven. We therefore analyzed short-term outcomes of laparoscopic and robotic low anterior rectal resection for rectal cancer. PATIENTS AND METHODS From 2011 to 2016, 44 robotic (RTME) and 41 laparoscopic (LTME) low anterior rectal resection with total mesorectal excision were performed at a single institution. Specimen quality was assessed and reported by an independent pathologist following international guidelines. RESULTS The groups did not differ significantly regarding gender, age, ASA stage, BMI, and distance of the lower tumor margin from the anal verge. More patients in the RTME group underwent preoperative chemoradiation (43.2 vs. 19.5%, p = 0.019). The quality of the TME specimen was significantly better in the RTME group (complete/nearly complete/incomplete for RTME 97/0/3% and for LTME 78/17/5%, p = 0.03). The conversion rate tended to be lower in the RTME group (7 vs. 17%, p = 0.143). There was no difference in CRM positivity between the groups. CONCLUSION Robotic surgery is safe and can improve the quality of TME for rectal cancer compared to laparoscopy. Any effect on long-term survival remains to be established.
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Affiliation(s)
- Heiko Aselmann
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Jan-Niclas Kersebaum
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Alexander Bernsmeier
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan Henrik Beckmann
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Thorben Möller
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan Hendrik Egberts
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Clemens Schafmayer
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Christoph Röcken
- Institut für Pathologie, Christian Albrechts Universität zu Kiel und Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Becker
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Matsuyama T, Kinugasa Y, Nakajima Y, Kojima K. Robotic-assisted surgery for rectal cancer: Current state and future perspective. Ann Gastroenterol Surg 2018; 2:406-412. [PMID: 30460343 PMCID: PMC6236106 DOI: 10.1002/ags3.12202] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/10/2018] [Accepted: 07/29/2018] [Indexed: 12/16/2022] Open
Abstract
Interest in minimally invasive surgery has increased in recent decades. Robotic-assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual-console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.
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Affiliation(s)
- Takatoshi Matsuyama
- Department of Gastrointestinal SurgeryTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Yasuaki Nakajima
- Department of Gastrointestinal SurgeryTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Kazuyuki Kojima
- Division of Minimally Invasive TreatmentTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
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Matsuda T, Yamashita K, Hasegawa H, Oshikiri T, Hosono M, Higashino N, Yamamoto M, Matsuda Y, Kanaji S, Nakamura T, Suzuki S, Sumi Y, Kakeji Y. Recent updates in the surgical treatment of colorectal cancer. Ann Gastroenterol Surg 2018; 2:129-136. [PMID: 29863145 PMCID: PMC5881369 DOI: 10.1002/ags3.12061] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/15/2018] [Indexed: 12/13/2022] Open
Abstract
Because of recent advances in medical technology and new findings of clinical trials, treatment options for colorectal cancer are evolutionally changing, even in the last few years. Therefore, we need to update the treatment options and strategies so that patients can receive optimal and tailored treatment. The present review aimed to elucidate the recent global trends and update the surgical treatment strategies in colorectal cancer by citing the literature published in the last 2 years, namely 2016 and 2017. Although laparoscopic surgery is still considered the most common approach for the treatment of colorectal cancer, new surgical technologies such as transanal total mesorectal excision, robotic surgery, and laparoscopic lateral pelvic lymph node dissection are emerging. However, with the recent evidence, superiority of the laparoscopic approach to the open approach for rectal cancer seems to be controversial. Surgeons should notice the risk of adverse outcomes associated with unfounded and uncontrolled use of these novel techniques. Many promising results are accumulating in preoperative and postoperative treatment including chemotherapy, chemoradiotherapy, and targeted therapy. Development of new biomarkers seems to be essential for further improvement in the treatment outcomes of colorectal cancer patients.
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Affiliation(s)
- Takeru Matsuda
- Division of Minimally Invasive Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Masayoshi Hosono
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Nobuhide Higashino
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yoshiko Matsuda
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yasuo Sumi
- Division of International Clinical Cancer Research Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
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