Skip to main content

Advertisement

SpringerLink
Log in

Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer: results of a single high-volume center in Japan

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

Abstract

Purpose

Scientific evidence supporting robotic-assisted laparoscopic surgery (RALS) for rectal cancer remains inconclusive because most previous reports were retrospective case series or case-control studies, with few reports focusing on long-term oncological outcomes with a large volume of patients. The aim of this study was to clarify the short- and long-term outcomes of a large number of consecutive patients with rectal cancer who underwent RALS in a single high-volume center.

Methods

The records of 551 consecutive patients who underwent RALS for rectal adenocarcinoma between December 2011 and March 2017 were examined to reveal the short-term outcomes. The oncological outcomes of the 204 patients who underwent surgery between December 2011 and March 2014 were evaluated.

Results

Most patients had tumors located in the lower or mid-rectum (86.0%). Only 7.6% of patients underwent neoadjuvant chemoradiotherapy. Lateral lymph node dissection was performed for 191 patients (34.7%). The median operative time was 257 min, median blood loss was 10 mL, and no transfusions were needed. No conversion to open surgery was necessary. Eighteen patients (3.3%) had Clavien-Dindo grade III postoperative complications. Six patients (1.1%) had positive resection margins. The mean follow-up duration of the 204 patients was 43.6 ± 9.8 (months). The 5-year cancer-specific survival rate for stage I/II/III/IV was 100%/100%/100%/not reached, respectively. The 5-year relapse-free survival rate for stage I/II/III/IV was 93.6%/75.0%/77.6%/ not reached, respectively. The rate of local recurrence was 0.5%.

Conclusions

Our results suggest that RALS is technically feasible for rectal cancer and has good short- and long-term outcomes.

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. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218. https://doi.org/10.1016/s1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  2. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645. https://doi.org/10.1016/s1470-2045(10)70131-5

    Article  PubMed  Google Scholar 

  3. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas M, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332. https://doi.org/10.1056/NEJMoa1414882

    Article  CAS  PubMed  Google Scholar 

  4. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (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(7):767–774. https://doi.org/10.1016/s1470-2045(14)70205-0

    Article  PubMed  Google Scholar 

  5. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726. https://doi.org/10.1016/s0140-6736(05)66545-2

    Article  PubMed  Google Scholar 

  6. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT Investigators (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009

    Article  CAS  PubMed  Google Scholar 

  7. Martinez-Perez A, Carra MC, Brunetti F, de'Angelis N (2017) Pathologic outcomes of laparoscopic vs open mesorectal excision for rectal cancer: a systematic review and meta-analysis. JAMA Surg 152(4):e165665. https://doi.org/10.1001/jamasurg.2016.5665

    Article  PubMed  Google Scholar 

  8. Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H, Yamakawa Y (2016) Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center. Surg Today 46(8):957–962. https://doi.org/10.1007/s00595-015-1266-4

    Article  PubMed  Google Scholar 

  9. Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H (2016) Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 30(2):721–728. https://doi.org/10.1007/s00464-015-4266-y

    Article  PubMed  Google Scholar 

  10. Kim JC, Yu CS, Lim SB, Park IJ, Kim CW, Yoon YS (2016) Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients. Int J Color Dis 31(6):1179–1187. https://doi.org/10.1007/s00384-016-2586-6

    Article  Google Scholar 

  11. Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261(1):129–137. https://doi.org/10.1097/sla.0000000000000613

    Article  PubMed  Google Scholar 

  12. 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(8):2485–2493. https://doi.org/10.1245/s10434-012-2262-1

    Article  PubMed  Google Scholar 

  13. Kim J, Baek SJ, Kang DW, Roh YE, Lee JW, Kwak HD, Kwak JM, Kim SH (2017) Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon rectum 60(3):266–273. https://doi.org/10.1097/dcr.0000000000000770

  14. Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furutani A, Manabe S, Yamaoka Y, Hino H (2018) Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 2(10):018–6197. https://doi.org/10.1007/s00464-018-6197-x

    Article  Google Scholar 

  15. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22(7):1601–1608. https://doi.org/10.1007/s00464-008-9752-z

    Article  CAS  PubMed  Google Scholar 

  16. Jimenez Rodriguez RM, Diaz Pavon JM, de La Portilla de Juan F, Prendes Sillero E, Hisnard Cadet Dussort JM, Padillo J (2011) Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection. Cir Esp 89(7):432–438. https://doi.org/10.1016/j.ciresp.2011.01.017

    Article  PubMed  Google Scholar 

  17. Sun Z, Kim J, Adam MA, Nussbaum DP, Speicher PJ, Mantyh CR, Migaly J (2016) Minimally invasive versus open low anterior resection: equivalent survival in a national analysis of 14,033 patients with rectal cancer. Ann Surg 263(6):1152–1158. https://doi.org/10.1097/sla.0000000000001388

    Article  PubMed  Google Scholar 

  18. Baik SH, Kim NK, Lim DR, Hur H, Min BS, Lee KY (2013) Oncologic outcomes and perioperative clinicopathologic results after robot-assisted tumor-specific mesorectal excision for rectal cancer. Ann Surg Oncol 20(8):2625–2632. https://doi.org/10.1245/s10434-013-2895-8

    Article  PubMed  Google Scholar 

  19. Sammour T, Malakorn S, Bednarski BK, Kaur H, Shin US, Messick C, You YQN, Chang GJ (2018) Oncological outcomes after robotic proctectomy for rectal cancer: analysis of a prospective database. Ann Surg 267(3):521–526. https://doi.org/10.1097/sla.0000000000002112

    Article  PubMed  Google Scholar 

  20. Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H (2014) Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Color Dis 29(9):1105–1111. https://doi.org/10.1007/s00384-014-1921-z

    Article  Google Scholar 

  21. Watanabe T, Muro K, Ajioka Y et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23(1):1–34. https://doi.org/10.1007/s10147-017-1101-6

    Article  PubMed  Google Scholar 

  22. Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, Eighth edn. Wiley-Blackwell, Oxford

    Google Scholar 

  23. Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255(6):1129–1134. https://doi.org/10.1097/SLA.0b013e3182565d9d

    Article  PubMed  Google Scholar 

  24. Kinugasa Y, Murakami G, Suzuki D, Sugihara K (2007) Histological identification of fascial structures posterolateral to the rectum. Br J Surg 94(5):620–626. https://doi.org/10.1002/bjs.5540

    Article  CAS  PubMed  Google Scholar 

  25. Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49(7):1024–1032. https://doi.org/10.1007/s10350-006-0557-7

    Article  PubMed  Google Scholar 

  26. Kagawa H, Kinugasa Y, Shiomi A, Yamaguchi T, Tsukamoto S, Tomioka H, Yamakawa Y, Sato S (2015) Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surg Endosc 29(4):995–1000. https://doi.org/10.1007/s00464-014-3760-y

    Article  PubMed  Google Scholar 

  27. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  28. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PWT, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sun Y, Xu H, Li Z, Han J, Song W, Wang J, Xu Z (2016) Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 14:61. https://doi.org/10.1186/s12957-016-0816-6

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jimenez-Rodriguez RM, Rubio-Dorado-Manzanares M, Diaz-Pavon JM et al (2016) Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Color Dis 31(12):1807–1815. https://doi.org/10.1007/s00384-016-2660-0

    Article  Google Scholar 

  31. Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, Tomioka H, Mori K (2015) Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29(7):1679–1685. https://doi.org/10.1007/s00464-014-3855-5

    Article  PubMed  Google Scholar 

  32. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) 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 318(16):1569–1580. https://doi.org/10.1001/jama.2017.7219

    Article  PubMed  PubMed Central  Google Scholar 

  33. Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R, Garbett C, Guillou P, Holloway I, Howard H, Marshall H, McCabe C, Pavitt S, Quirke P, Rivers CS, Brown JMB (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Color Dis 27(2):233–241. https://doi.org/10.1007/s00384-011-1313-6

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Tomohiro Yamaguchi, Yusuke Kinugasa, Akio Shiomi, Hiroyasu Kagawa, Yushi Yamakawa, Akinobu Furuatni, Shoichi Manabe, Yusuke Yamaoka & Hitoshi Hino

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan

    Tomohiro Yamaguchi

  3. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Yusuke Kinugasa

Authors
  1. Tomohiro Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Kinugasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akio Shiomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroyasu Kagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yushi Yamakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akinobu Furuatni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shoichi Manabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yusuke Yamaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hitoshi Hino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Kinugasa.

Ethics declarations

The study protocol was approved by the institutional review board.

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamaguchi, T., Kinugasa, Y., Shiomi, A. et al. Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer: results of a single high-volume center in Japan. Int J Colorectal Dis 33, 1755–1762 (2018). https://doi.org/10.1007/s00384-018-3153-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-3153-0

Keywords

Search

Navigation