Total mesorectal excision for rectal cancer – laparoscopic versus robotic approach
Authors:
M. Škrovina 1,2; M. Macháčková 1; L. Martínek 3; V. Benčurik 1; M. Dosoudil 1; J. Bartoš 1; P. Anděl 1,4; H. Hlavíková 1
Authors‘ workplace:
Chirurgické oddělení, Nemocnice AGEL Nový Jičín, a. s., Centrum vysoce specializované onkologické péče pro dospělé Nový Jičín
1; 1. Chirurgická klinika, Fakultní nemocnice Olomouc
2; Chirurgická klinika, Fakultní nemocnice Ostrava
3; Bebinko Anděl, s. r. o., Ostrava-Poruba
4
Published in:
Rozhl. Chir., 2021, roč. 100, č. 11, s. 527-532.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2021.100.11.527–533
Overview
Introduction: The primary goal of this study was to evaluate peroperative and early postoperative results of laparoscopic and robotic surgery for rectal cancer with total mesorectal excision (TME) and with primary anastomosis.
Methods: 404 patients were enrolled in the study, divided in two cohorts and compared retrospectively: a laparoscopic group (n=236) versus a robotic (TME + primary coloanal anastomosis) group (n=168). The evaluated cohorts were comparable in sex, age, BMI, ASA score, distal tumor margin from anal verge and neoadjuvant chemoradiotherapy. More advanced tumor stages were observed in the robotic group (p=0.009).
Results: The duration of robotic resection was significantly longer compared to laparoscopic resection (p<0.001). Peroperative blood loss (p=0.036), as well as the overall length of hospital stay were significantly lower in the robotic group (p=0.008). No differences were observed in terms of reoperations and intraoperative and postoperative complications. The number of lymph nodes in the histological specimen was higher in the laparoscopic group (p=0.703). Incomplete TME was observed in 4% of laparoscopically operated patients and no patients of the robotic group (p=0.092).
Conclusion: Robotic resection of rectal cancer is a promising technique that can help reach better overall quality of surgical intervention in a wider group of patients at departments with sufficiently experienced surgeons and a large volume of thus treated patients.
Keywords:
rectal cancer – robotic resection – total mesorectal excission
Sources
1. Brenner H, Bouvier AM, Foschi R, et al. Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study. Int J Cancer 2012;131:1649−1658. doi:10.1002/ijc.26192.
2. Heald RJ, Ryall RDH, Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;327:1479−1482. doi:10.1016/ s0140-6736(86)91510-2.
3. Askari A, Nachiappan S, Currie A, et al. Selection for laparoscopic resection confers a survival benefit in colorectal cancer surgery in England. Surg Endosc. 2016;30:3839−3847. doi:10.1007/ s00464-015-4686-8.
4. Arezo A, Pasera R, Scozzari G, et al. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc. 2013;27:1485−1502. doi:10.1007/ s00464-012-2649-x.
5. Li Y, Wang S, Gao S, et al. Laparoscopic colorectal resection versus open colorectal resection in octogenerians: a systematic review and meta-analysis of safety and efficacy. Tech Coloproctol. 2016;20:153−162. doi:10.1007/s10151- 015-1419-x.
6. Ihnát P, Martínek L, Mitták M, et al. Quality of life laparoscopic after open resection of colorectal cancer. Dig Surg. 2014;31:161−168. doi:10.1159/000363415.
7. Fujii S, Ota M, Ichikawa Y, et al. Comparison of short, long-term surgical outcomes and mid-term health-related quality of life after laparoscopic and open resection for colorectal cancer: a casematched control study. Int J Colorectal Dis. 2010;25:1311−1323. doi:10.1007/ s00384-010-0981-y.
8. Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20:1521−1525. doi:10.1007/ s00464-005-0855-5.
9. Benčurik V, Škrovina M, Martínek L, et al. Intraoperative fluorescence angiography and risk factors of anastomotic leakage in mini-invasive low rectal resections. Surg Endosc. 2020 Sep 24. doi:10.1007/ s00464-020-07982-x.
10. Skrovina, M, Bencurik V, Martinek L, et al. The significance of intraoperative fluorescence angiography in miniinvasive low rectal resections. Wideochir Inne Tech Maloinwazyjne 2020;15(1):43−48. doi:10.5114/wiitm.2019.84851.
11. Milone M, Manigrasso M, Velotti N, et al. Completeness of total mesorectum excision of laparoscopic versus robotic surgery: a review with a meta-analysis. Int J Colorectal Dis. 2019;34:983−991. doi:10.1007/s00384-019-03307-0.
12. Tong G, Zhang G, Zheng Z, et al. Robotic and robotic-assisted vs laparoscopic rectal cancer surgery: A meta-analysis of short-term and long-term results. Asian Journal of Surgery 2021 May 26;11(1):11001. doi:10.1016/j.asjsur. 2021.08.053.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 11
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