Robotic resection of the rectum – what are the advantages?
Authors:
F. Pazdírek; M. Vjaclovský; P. Kocian; M. Bockova; J. Hoch
Authors‘ workplace:
Chirurgická klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha, Česká republika
Published in:
Rozhl. Chir., 2023, roč. 102, č. 12, s. 459-463.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2023.102.12.459–463
Overview
Introduction: Surgical treatment is the most important part of multimodal management of rectal cancer. In recent years, minimally invasive surgery has been preferred. Minimally invasive procedures include laparoscopy and more recently robotic surgery. Robotic surgery has been developed to eliminate the shortcomings of laparoscopy, especially the parallel position of instruments and their limited movement. The advantages of a robotic system should be most apparent in narrow and deep spaces, i.e. the lesser pelvis. The aim of this study was to analyze the short-term results of robot-assisted surgery for rectal tumors.
Methods: The study is a retrospective analysis of a cohort of 220 patients with robotic-assisted surgery for rectal cancer. The cohort was analyzed in terms of length of surgery, blood loss, number of conversions to open surgery, completeness of TME, distal and circumferential resection margin positivity, length of hospital stays and number of 30-day rehospitalizations. In addition, 30-day postoperative morbidity and mortality were assessed using the Clavien-Dindo score.
Results: Robotic-assisted surgeries lasted an average of 184 minutes. In total, 5 operations were converted, i.e. 2.3%. Complete mesorectum was achieved in 90% of the patients. Severe postoperative complications, Clavien-Dindo score 3–4, were observed in 14% of the patients. Anastomotic complications occurred in 9.6% of the patients. The mean length of the hospital stay was 8.4 days.
Conclusion: Robotic surgery for rectal tumors is a safe method with an acceptable rate of complications. An established training method and a high degree of standardization of the surgical procedures are indisputable advantages of robotic systems, making it possible to achieve very good results in a short time. In terms of perioperative and early postoperative outcomes, robotic surgery outperforms laparoscopic surgery in some parameters.
Sources
- Quirke P, Dixon MF, Durdey P, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: Histopathological study of lateral tumour spread and surgical excision. The Lancet 1986;328(8514):996–999. doi:10.1016/ S0140-6736(86)92612-7.
- Wang CL, Qu G, Xu HW. The shortand long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis. 2014;29(3):309–320. doi:10.1007/s00384-013-1827-1.
- George EI, Brand TC, LaPorta A, et al. Origins of robotic surgery: From skepticism to standard of care. JSLS 2018;22(4). doi:10.4293/JSLS.2018.00039.
- Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2018; 29(Suppl 4):iv263. doi:10.1093/annonc/ mdy161.
- Kiss I. Modrá kniha České onkologické společnosti. Masarykův onkologický ústav, Brno 2021.
- Hoch J, Ferko A, Bláha M, et al. Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma results of a multicenter study. [In Czech language]. Rozhledy v chirurgii 2016;95(7):262–267.
- Loughrey MB, Webster F, Arends MJ, et al. Dataset for pathology reporting of colorectal cancer: Recommendations from the International Collaboration on Cancer Reporting (ICCR). Annals of Surgery 2022;275(3):e549–e61. doi:10.1097/ sla.0000000000005051.
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery 2004;240(2):205–213. doi:10.1097/01.sla.0000133083.54934.ae.
- 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(3):339–351. doi:10.1016/j. surg.2009.10.012.
- Miskovic D, Ahmed J, Bissett-Amess R, et al. European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis. 2019;21(3):270–276. doi:10.1111/codi.14502.
- Kocián P, Pazdírek F, Přikryl P, et al. Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care? Acta Chirurgica Belgica 2023;123(2):163–169. doi:10.1080/00015458.2021.1971871.
- Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? The British Journal of Surgery 1982;69(10):613–616.
- Lin S, Jiang HG, Chen ZH, et al. Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol. 2011;17(47):5214–5220. doi: 10.3748/wjg.v17.i47.5214.
- Liao G, Li YB, Zhao Z, et al. Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Scientific Reports 2016;6:26981. doi:10.1038/srep26981.
- Ishihara S, Kiyomatsu T, Kawai K, et al. The short-term outcomes of robotic sphincter-preserving surgery for rectal cancer: comparison with open and laparoscopic surgery using a propensity score analysis. Int J Colorectal Dis. 2018;33(8):1047– 1055. doi:10.1007/s00384-018-3056-0.
- Khajeh E, Aminizadeh E, Dooghaie Moghadam A, et al. Outcomes of robot-assisted surgery in rectal cancer compared with open and laparoscopic surgery. Cancers (Basel) 2023;15(3). doi:10.3390/ cancers15030839.
- Trastulli S, Farinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis. 2012;14(4):e134–156. doi: 10.1111/j.1463-1318.2011.02907.x.
- 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(16):1569–1580. doi:10.1001/jama.2017.7219.
- Barrie J, Jayne DG, Wright J, et al. Attaining surgical competency and its implications in surgical clinical trial design: a systematic review of the learning curve in laparoscopic and robot-assisted laparoscopic colorectal cancer surgery. Ann Surg Oncol. 2014;21(3):829–840. doi:10.1245/s10434-013-3348-0.
- Tang B, Lei X, Ai J, et al. Comparison of robotic and laparoscopic rectal cancer surgery: a meta-analysis of randomized controlled trials. World J Surg Oncol. 2021;19(1):38. doi:10.1186/s12957-021-02128-2.
- Kim MJ, Park SC, Park JW, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: A phase II open label prospective randomized controlled trial. Annals of Surgery 2018;267(2):243–51. doi:10.1097/sla.0000000000002321.
- Feng Q, Yuan W, Li T, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(11):991–1004. doi:10.1016/ S2468-1253(22)00248-5.
- Xu J, Yuan W, Li T, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): Short-term outcomes of a multicenter randomized controlled trial. Journal of Clinical Oncology 2022;40(4_suppl). doi:10.1200/ JCO.2022.40.4_suppl.014.
- de Jesus JP, Valadão M, de Castro Araujo RO, et al. The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer. EJSO 2016;42(6):808–812. doi:10.1016/j. ejso.2016.03.002.
- Guo Y, Luo Y, Song X, et al. Comparison of pathologic outcomes of robotic and open resections for rectal cancer: A systematic review and meta-analysis. PLoS One 2021;16(1):e0245154. doi:10.1371/journal.pone.0245154.
- Prete FP, Pezzolla A, Prete F, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Annals of Surgery 2018;267(6):1034–1046. doi:10.1097/sla.0000000000002523.
- Bliss LA, Maguire LH, Chau Z, et al. Readmission after resections of the colon and rectum: Predictors of a costly and common outcome. Diseases of the Colon and Rectum 2015;58(12):1164–1173. doi:10.1097/DCR.0000000000000433.
- Skrovina M, Machackova M, Martinek L, et al. Total mesorectal excision for rectal cancer – laparoscopic versus robotic approach [In Czech]. Rozhledy v chirurgii 2021;100(11):527–532. doi:10.33699/PIS.2021.100.11.527-533.
- Langer D, Vocka M, Kalvach J, et al. Robotic-assisted surgery for rectal cancer results of a non-randomized study [In Czech]. Rozhledy v chirurgii 2021;100(5):227–231. doi:10.33699/PIS.2021.100.5.229-233.
- Kowalewski KF, Seifert L, Ali S, et al. Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis. Surgical Endoscopy 2021;35(1):81–95. doi: 10.1007/s00464-019-07361-1.
- Fayers P, Bottomley A, Group EQoL, Unit QoL. Quality of life research within the EORTC-the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer. Eur J Cancer. 2002;38 Suppl 4:S125–133. doi:10.1016/s09598049(01)00448-8.
- Qiu H, Yu D, Ye S, et al. Long-term oncological outcomes in robotic versus laparoscopic approach for rectal cancer: A systematic review and meta-analysis. Int J Surg. 2020;80:225–230. doi:10.1016/j. ijsu.2020.03.009.
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