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The impact of robotic total mesorectal excision on survival of patients with rectal cancer—a propensity matched analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Robotic surgery can overcome some limitations of laparoscopic total mesorectal excision (L-TME), improving the quality of the surgery. We aim to compare the medium-term oncological outcomes of L-TME vs. robotic total mesorectal excision (R-TME) for rectal cancer.

Methods

A retrospective analysis was performed including patients who underwent L-TME or R-TME between 2011 and 2017. Patients presenting with metastatic disease or R1 resection were excluded. From a total of 680 patients, 136 cases of R-TME were matched based on age, gender, stage and time of follow-up with an equal number of patients who underwent L-TME. We compared 3-year disease-free survival (DFS) and overall survival (OS).

Results

Major complications were lower in the robotic group (13.2% vs. 22.8%, p = 0.04), highlighting the anastomotic leakage rate (7.4% vs. 16.9%, p = 0.01).

The 3-year DFS rate for all stages was 69% for L-TME and 84% for R-TME (p = 0.02). For disease stage III, the 3-year DFS was significantly higher in the R-TME group. OS was also significantly superior in the robotic group for every stage, reaching 86% in stage III.

In the multivariate analysis, R-TME was a significant positive prognostic factor for distant metastasis (OR 0.2 95% CI 0.1, 0.6, p = 0.001) and OS (OR 0.2 95% CI 0.07, 0.4, p = 0.000). Moreover, major complications were also found to have a negative impact on OS (OR 8.3 95% CI 3.2, 21.6, p = 0.000).

Conclusion

R-TME for rectal cancer can achieve better oncological outcomes compared with L-TME, especially in stage III rectal cancers. However, a longer follow-up period is needed to confirm these findings.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK

    P. Tejedor, F. Sagias, K. Flashman, Yeh Han Lee, S. Naqvi & Jim Khan

  2. Faculty of Sciences, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK

    N. Kandala

  3. School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK

    Jim Khan

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  1. P. Tejedor
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  2. F. Sagias
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  3. K. Flashman
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All authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.

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Correspondence to Jim Khan.

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The authors declare that they have no conflict of interest. All procedures performed in studies involving humans were in accordance with ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all participants.

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Tejedor, P., Sagias, F., Flashman, K. et al. The impact of robotic total mesorectal excision on survival of patients with rectal cancer—a propensity matched analysis. Int J Colorectal Dis 34, 2081–2089 (2019). https://doi.org/10.1007/s00384-019-03417-9

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