Skip to main content

Advertisement

SpringerLink
Log in

Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Because there are few comparative studies of open, laparoscopy-assisted (LA), and robot-assisted (RA) total mesorectal excision (TME) for rectal cancer, we aimed to compare these three procedures in terms of sphincter-saving operation (SSO) achievement, surgical complications, and early oncological outcomes.

Methods

The short-term outcomes of 2114 patients with rectal cancer consecutively enrolled between July 2010 and February 2015 at Asan Medical Center (Seoul, Korea) were retrospectively evaluated. Patients underwent either open, LA, or RA TME (n = 1095, 486, and 533, respectively) performed by experienced surgeons.

Results

RA TME was a significant determinant of SSO in multivariate analysis that included potential variables such as tumor location and T4 category (odds ratio, 2.458; 95 % confidence interval, 1.497–4.036; p < 0.001). The cumulative rates of 3-year local recurrence, overall survival, and disease-free survival did not differ among the three groups: 2.5–3.4, 91.9–94.6, and 82.2–83.1 % (p = 0.85, 0.352, and 0.944, respectively). Early general surgical complications occurred more frequently in the open group than in the LA and RA groups (19.3 versus 13.0 versus 12.2 %, p < 0.001), specifically ileus and wound infection.

Conclusions

There were no significant differences in 3-year survival outcomes and local recurrence among open, LA, and RA TME. RA TME is useful for SSO achievement, regardless of advanced stage and location of rectal cancer. The open procedure had a slightly but significantly higher incidence of postoperative complications than LA and RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Vennix S, Pelzers L, Bouvy N et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4, CD005200

    PubMed  Google Scholar 

  2. Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B (2000) Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 356:93–96

    Article  CAS  PubMed  Google Scholar 

  3. Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701

    Article  PubMed  Google Scholar 

  4. Lange MM, Rutten HJ, van de Velde CJ (2009) One hundred years of curative surgery for rectal cancer: 1908–2008. Eur J Surg Oncol 35:456–463

    Article  CAS  PubMed  Google Scholar 

  5. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645

    Article  CAS  PubMed  Google Scholar 

  6. Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  CAS  PubMed  Google Scholar 

  7. Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774

    Article  PubMed  Google Scholar 

  8. Smith JJ, Garcia-Aguilar J (2015) Advances and challenges in treatment of locally advanced rectal cancer. J Clin Oncol 33:1797–1808

    Article  PubMed  Google Scholar 

  9. Miskovic D, Foster J, Agha A et al (2015) Standardization of laparoscopic total mesorectal excision for rectal cancer: a structured international expert consensus. Ann Surg 261:716–722

    Article  PubMed  Google Scholar 

  10. Kim CW, Kim CH, Baik SH (2014) Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 18:816–830

    Article  PubMed  Google Scholar 

  11. Araujo SE, Seid VD, Klajner S (2014) Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes. World J Gastroenterol 20:14359–14370

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim JC, Yang SS, Jang TY, Kwak JY, Yun MJ, Lim SB (2012) Open versus robot-assisted sphincter-saving operations in rectal cancer patients: techniques and comparison of outcomes between groups of 100 matched patients. Int J Med Robot 8:468–475

    Article  PubMed  Google Scholar 

  13. Kim JC, Lim SB, Yoon YS, Park IJ, Kim CW, Kim CN (2014) Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery. Surg Endosc 28:2734–2744

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E (2014) Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg 260:993–999

    Article  PubMed  Google Scholar 

  16. Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J (2015) Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg 262:1040–1045

    Article  PubMed  Google Scholar 

  17. Kim JC, Yu CS, Lim SB, Kim CW, Park IJ, Yoon YS (2015) Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients. Int J Colorectal Dis 30:1311–1321

    Article  PubMed  Google Scholar 

  18. Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617

    Article  PubMed  Google Scholar 

  19. Park EJ, Cho MS, Baek SJ et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137

    Article  PubMed  Google Scholar 

  20. Dinnewitzer A, Jäger T, Nawara C, Buchner S, Wolfgang H, Öfner D (2013) Cumulative incidence of permanent stoma after sphincter preserving low anterior resection of mid and low rectal cancer. Dis Colon Rectum 56:1134–1142

    Article  PubMed  Google Scholar 

  21. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19:2485–2493

    Article  PubMed  Google Scholar 

  22. Lim RS, Yang TX, Chua TC (2014) Postoperative bladder and sexual function in patients undergoing surgery for rectal cancer: a systematic review and meta-analysis of laparoscopic versus open resection of rectal cancer. Technol Coloproctol 18:993–1002

    Article  CAS  Google Scholar 

  23. Pahlman L, Bujko K, Rutkowski A, Michalski W (2013) Altering the therapeutic paradigm towards a distal bowel margin of <1 cm in patients with low-lying rectal cancer: a systematic review and commentary. Colorectal Dis 15:e166–e174

    Article  CAS  PubMed  Google Scholar 

  24. Lykke J, Roikjaer O, Jess P, Danish Colorectal Cancer Group (2014) Tumour stage and preoperative chemoradiotherapy influence the lymph node yield in stages I-III rectal cancer: results from a prospective nationwide cohort study. Colorectal Dis 16:O144–O149

    Article  CAS  PubMed  Google Scholar 

  25. Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268

    Article  PubMed  PubMed Central  Google Scholar 

  26. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 1, CD005033

    PubMed  Google Scholar 

  27. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grants (to J.C. Kim) from the Korea Research Foundation (2013R1A2A1A03070986), Ministry of Science, ICT, and Future Planning, and the Korea Health 21 R&D Project (HI06C0868 and HI13C1750), Ministry of Health, Welfare, and Family Affairs, Republic of Korea. We gratefully acknowledge the expert assistance of Dr. J. Y. Lee, Mr. Y. J. Yoon, Ms. J. R. Kim, and H. J. Jung.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, In Ja Park, Chan Wook Kim & Yong Sik Yoon

  2. Institute of Innovative Cancer Research, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Jin Cheon Kim

Authors
  1. Jin Cheon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Sik Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seok-Byung Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In Ja Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chan Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Sik Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Cheon Kim.

Ethics declarations

All patients provided written informed consent, and the study protocol was approved by the Institutional Review Board of Asan Medical Center (registration number: 2015-0973) in accordance with the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

Role of the funding source

None

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Fig. 1

Mean fold ratios of basic manometric parameters of evaluable patients (open/LA/RA groups: n = 182/52/251 patients). The data represent the ratios of the values obtained at 6–12 postoperative months to the preoperative values and were compared using an analysis or variance (ANOVA) test. MRP, maximal resting pressure; MSP, maximal squeezing pressure; UDV, urge to defecate volume; MTV, maximal tolerance volume. (GIF 37 kb)

High Resolution Image (TIF 446 kb)

Supplementary Fig. 2

Overall survival (a–c) and disease-free survival (d–f) of the open, LA, and RA groups according to the respective stage. Survival outcomes were compared using the Kaplan–Meier method with the log-rank test. LA, laparoscopy-assisted; RA, robot-assisted; OS, overall survival; DFS, disease-free survival. (GIF 57 kb)

High Resolution Image (TIF 1523 kb)

Table S1

Parameters associated with SSO achievementa (DOCX 27 kb)

Table S2

Parameters associated postoperative ileus and anastomotic complicationsa (DOCX 25 kb)

Table S3

Parameters associated 3-year local recurrence (DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.C., Yu, C.S., Lim, SB. et al. Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients. Int J Colorectal Dis 31, 1179–1187 (2016). https://doi.org/10.1007/s00384-016-2586-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2586-6

Keywords

Search

Navigation