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Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes
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Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes
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Journal Article
Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes
2010
Overview
Background
We assessed feasibility, short-term oncologic safety, and short-term outcomes in robotic total mesorectal excision (R-TME) for rectal cancer compared with laparoscopic TME.
Methods
From March 2008 to June 2009, 50 patients with proven middle/lower rectal adenocarcinoma underwent minimally invasive TME; 25 received R-TME. The groups were balanced (R-TME versus L-TME) in terms of age (median 69 versus 62 years;
p
= 0.8), disease stage, and body mass index (median 23 versus 26.5 kg/m
2
;
p
= 0.06). There were 37 (74%) anterior resections and 13 (26%) abdominoperineal resections. Twenty-three (46%) patients received preoperative radiochemotherapy. The robot was a four-arm Da Vinci S (Intuitive Surgical, Sunnyvale, CA, USA).
Results
Median operating time (R-TME versus L-TME) was 240 versus 237 min (
p
= 0.2); first bowel movement was 2 versus 3 days (
p
= 0.5); median hospital stay was 6.5 versus 6 days (
p
= 0.4). Major complications with reoperation were two in R-TME (one anastomotic leakage, one small bowel perforation) and three in L-TME (one colonic ischemia, two anastomotic leakage). Postoperative complications were 16% versus 24% (
p
= 0.5). A median of 18 versus 17 (
p
= 0.7) lymph nodes were retrieved; distal resection margins were disease free in both groups; circumferential margin was involved (<1.0 mm) in one (4%) of L-TME. There were 0 versus 1 (5%) conversions to laparotomy.
Conclusions
R-TME in rectal cancer is feasible, with short-term oncologic and other outcomes similar to those of L-TME. The greater maneuverability and visibility afforded by the robotic approach are attractive. Future studies should more systematically address advantages and costs of R-TME.
Publisher
Springer-Verlag,Springer,Springer Nature B.V
Subject
/ Adult
/ Aged
/ Biological and medical sciences
/ Computer science; control theory; systems
/ Exact sciences and technology
/ Female
/ Humans
/ Intraoperative Complications
/ Investigative techniques, diagnostic techniques (general aspects)
/ Laparoscopy - adverse effects
/ Male
/ Medicine
/ Rectal Neoplasms - pathology
/ Robotics
/ Stomach, duodenum, intestine, rectum, anus
/ Surgery
/ Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
