Robotic-assisted surgery for rectal cancer − results of a non-randomized study
Authors:
D. Langer 1; M. Vočka 2; J. Kalvach 1; J. Pažin 1; M. Ryska 1; Radek Pohnán 1
Authors‘ workplace:
Chirurgická klinika 2. lékařské fakulty Univerzity Karlovy, Ústřední vojenská nemocnice Praha – Vojenská fakultní, nemocnice
1; Onkologická klinika Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha
2
Published in:
Rozhl. Chir., 2021, roč. 100, č. 5, s. 227-231.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2021.100.5.229–233
Overview
Introduction: The Czech Republic belongs to countries in which colorectal cancer significantly contributes to the overall oncological burden. Radical removal of tumor-affected tissues plays a key role in the multimodal therapy of rectal cancer. In the first decade of the third millennium the mini-invasive approach in rectal cancer surgery gradually expanded to include robotic-assisted surgeries. The aim of this paper is to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries.
Methods: 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 01 Jan 2016 and 31 Dec 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analyzed − gender, age, body mass index (BMI), ASA (American Society of Anesthesiologist) classification, stage of cancer according to TNM classification (UICC), tumor location, neoadjuvant chemoradiotherapy, operative time, blood loss, anastomotic leaks, surgical complications, 30-day mortality, local and metastatic recurrence and the length of follow-up. The data were analyzed using methods of descriptive statistics.
Results: 204 patients with rectal cancer (RC) of whom 138 were men and 66 were women underwent robotic surgery at our department during the five years period. In 97 (47.5%) cases the disease was diagnosed in an advanced stage (stages III and IV of the TNM classification). Eighteen patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the diagnosis. Liver first approach was indicated in 8 (44.4%) patients; two patients underwent radical resection of liver lesions with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease; partial mesorectal excision was performed in 68 cases. Eighteen complications were documented in the entire group. Clinically relevant anastomotic leak with the need of therapy occurred in 5 (3.6%) cases. Surgical therapy was needed in more than half of the cases (61.1%). One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Recurrence of secondary liver disease or metachronous liver lesions occurred in 17 patients, most (76.5%) underwent liver resection with curative intent. The median follow-up period was 20 months.
Conclusion: Surgical therapy is the only potentially curative therapy for rectal cancer (RC). Robotic-assisted surgery has become a routine therapeutic modality for RC worldwide during the first two decades of the third millennium. Da Vinci assisted surgeries dominate at the authors’ center in the surgical treatment of RC. Compared to open and laparoscopic resections of RC, robotic-assisted operations achieve the same clinical and oncological results with a lower frequency of complications.
Keywords:
rectal carcinoma – robotic rectal surgery – clinical and oncological outcomes – follow-up
Sources
1. Dušek L. Zhoubné nádory trávicího traktu: Výzva pro zdravý životní styl, screening a organizaci léčebné péče. European digestive cancer days 2017 (dodatečné informace k tiskové zprávě).
2. www.svod.cz
3. Sahni VA, Silveira PC, Sainani NI, et al. Impact of a structured report template on the quality of MRI reports for rectal cancer staging. AJR Am J Roentgenol. 2015;205(3):584−588. doi: 10.2214/ AJR.14.14053.
4. Ryska M, Langer D. Chirurgická léčba kolorektálního karcinomu. Onkologie 2013;7(4):179–182.
5. Ryska M, Langer D, Kalvach J. Některé současné aspekty chirurgické léčby kolorektálního karcinomu. Onkol Rev. 2017;2:24−29.
6. Miskovic D, Ahmed J, BissetT-Amess et al. European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis. 2019;21:270−276. doi: 101111/codi.14502.
7. Hoch J, Ferko A, Blaha M, et al. Parametrické sledování kvality totální mezorektální excize a chirurgické léčby karcinomu rekta – výsledky multicentrické studie. Rozhl Chir. 2016;95:262-271.
8. Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010;147:339−351. doi: 10.1016/j. surg.2009.10.012.
9. Dušek L. Czech cancer care in numbers 2008−2009. Praha, Grada Publishing 2009.
10. Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc. 2006;20:1713−1718. doi: 10.1007/s00464-005-0771-8.
11. Baek JH, Pastor C, Pigazzi A. Robotic and laparoscopic total mesorectal exciton for rectal cancer: a case-matched study. Surg Endosc. 2011;25:521−525. doi: 10.1007/ s00464-010-1204-x.
12. Prete FP, Pezzolla A, Prete F, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer. A systematic rereview and meta-analysis of randomized controlled trials. Ann Surg. 2018;267:1034−1046. doi: 10.1097/ SLA.0000000000002523.
13. Kim MJ, Park SCh, Park JW, et al. Robot- -assisted versus laparoscopic surgery for rectal cancer: A phase II open label prospective randomized controlled trial. Ann Surg. 2018;267:243−251. doi: 10.1097/ SLA0000000000002321.
14. Jayne D, Pigazzi A, Marshall H, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. The ROLARR randomized clinical trial. JAMA 2017;318:1569−1580. doi: 10.1001/ jama.2017.7219.
15. D‘Annibale A, Pernazza G, Monsellato I, et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc. 2013;27:1887−1895. doi:10.1007/s00464- 012-2731-4.
16. Crippa J, Grass F, Dozois E, et al. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort. Ann Surg. 2020. Online ahead of print. doi: 10.1097/ SLA.0000000000003805.
17. Kowalewski KF, Seifert L, Ali S, et al. Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis. Surg Endosc. 2021;35:81−95. https://doi. org/10.1007//s00464-019-07361-1.
18. Hu JM, Chu ChH, Jiang JK, et al. Robotic transanal total mesorectal excision assisted by laparoscopic transabdominal approach: A preliminary twenty-case series report. Asian Journal of Surgery 2020;43:330−338. https://doi. org/10.1016/j.asjsur.2019.06.010.
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