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Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer

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Abstract

Background

Long-term data from the CLASICC study demonstrated the oncologic equivalence of laparoscopic and open rectal cancer surgery despite an increased circumferential resection margin involvement in the laparoscopic group in the initial report. Moreover, laparoscopic total mesorectal excision (TME) may be associated with increased rates of male sexual dysfunction compared to conventional open TME. Robotic surgery could potentially obtain better results than laparoscopy. The aim of this study was to compare the clinical and functional outcomes of robotic and laparoscopic surgery in a single-center experience.

Methods

This study was based on 100 patients who underwent minimally invasive anterior rectal resection with TME. Fifty consecutive robotic rectal anterior resections with TME (R-TME) were compared to the first 50 consecutive laparoscopic rectal resections with TME (L-TME).

Results

Median operative time was 270 min in R-TME and 275 min in L-TME. No conversions occurred in the R-TME group whereas six conversions occurred in the L-TME group. The mean number of harvested lymph nodes was 16.5 ± 7.1 for R-TME and 13.8 ± 6.7 for L-TME. The circumferential margin (CRM) was <2 mm in six L-TME patients, whereas no one in R-TME group had a CRM <2 mm. The International Prostate Symptom Score (IPSS) scores were significantly increased 1 month after surgery in both the L-TME and R-TME groups, but they normalized 1 year after surgery. Erectile function worsened significantly 1 month after surgery in both the groups but it was restored completely 1 year after surgery in the R-TME group and partially in the L-TME group.

Conclusions

Robotic TME is oncologically safe and adequate for rectal cancer treatment, showing better results than laparoscopic TME in terms of CRM, conversions, and hospital length of stay. Better recovery in voiding and sexual function is achieved with the robotic technique.

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Acknowledgments

We thank Dr. Marina Rosito and Dr. Tania Contardo for helping us collect the data.

Disclosures

Drs. D’Annibale, Pernazza, Monsellato, Pende, Lucandri, Mazzocchi, and Alfano have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Minimally Invasive and Robotic Surgery Unit, San Giovanni Addolorata Hospital, Via dell’Amba Aradam 9, Rome, Italy

    Annibale D’Annibale, Graziano Pernazza, Igor Monsellato, Vito Pende, Giorgio Lucandri, Paolo Mazzocchi & Giovanni Alfano

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  1. Annibale D’Annibale
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  2. Graziano Pernazza
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  3. Igor Monsellato
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Correspondence to Graziano Pernazza.

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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 27, 1887–1895 (2013). https://doi.org/10.1007/s00464-012-2731-4

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  • DOI: https://doi.org/10.1007/s00464-012-2731-4

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