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Transition from laparoscopic to robotic approach in rectal cancer: a single-center short-term analysis based on the learning curve

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Abstract

As a novel procedure becomes more and more used, knowledge about its learning curve and its impact on outcomes is useful for future implementations. Our aim is (i) to identify the phases of the robotic rectal surgery learning process and assess the safety and oncological outcomes during that period, (ii) to compare the robotic rectal surgery learning phases outcomes with laparoscopic rectal resections performed before the implementation of the robotic surgery program. We performed a retrospective study, based on a prospectively maintained database, with methodological quality assessment by STROBE checklist. All the procedures were performed by the same two surgeons. A total of 157 robotic rectal resections from June 2018 to January 2022 and 97 laparoscopic rectal resections from January 2018 to July 2019 were included. The learning phase was completed at case 26 for surgeon A, 36 for surgeon B, and 60 for the center (both A & B). There were no differences in histopathological results or postoperative complications between phases, achieving the same ratio of mesorectal quality, circumferential and distal resection margins as the laparoscopic approach. A transitory increase of major complications and anastomotic leakage could occur once overcoming the learning phase, secondary to the progressive complexity of cases. Robotic rectal cancer surgery learning curve phases in experienced laparoscopic surgeons was completed after 25–35 cases. Implementation of a robotic rectal surgery program is safe in oncologic terms, morbidity, mortality and length of stay.

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Data availability

The data that support the findings of this study are available from the authors but restrictions apply to the availability of these data, not having been initially consented to its public diffusion, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission from the Ethics Committee and the General and Digestive Surgery Department from University Hospital Reina Sofía, Córdoba, Spain.

Abbreviations

BMI:

Body mass index

ASA:

American society of anesthesiologist

CRM:

Circumferential resection margin

RRR:

Robotic rectal resection

LRR:

Laparoscopic rectal resection

CUSUM:

Cumulative sum

LP:

Learning phase

CP:

Competence phase

TME:

Total mesorectal excision

DRM:

Distal resection margin

COT:

Console operative time

References

  1. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  2. Miyajima N, Fukunaga M, Hasegawa H, Tanaka J, Okuda J, Watanabe M et al (2009) Results of a multicenter study of 1057 cases of rectal cancer treated by laparoscopic surgery. Surg Endosc 23:113–118

    Article  PubMed  Google Scholar 

  3. Staudacher C, Vignali A (2010) Laparoscopic surgery for rectal cancer: the state of the art. World J Gastrointest Surg 2:275–282

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jimenez Rodriguez RM, Diaz Pavon JM, de Juan FDLP, 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 89:432–438

    PubMed  Google Scholar 

  5. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 54:151–156

    Article  PubMed  Google Scholar 

  6. Jimenez-Rodriguez RM, Rubio-Dorado-Manzanares M, Diaz-Pavon JM, Reyes-Diaz ML, Vazquez-Monchul JM, Garcia-Cabrera AM et al (2016) Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Colorectal Dis 31:1807–1815

    Article  PubMed  Google Scholar 

  7. Longmore SK, Naik G, Gargiulo GD (2020) Laparoscopic robotic surgery: current perspective and future directions. Robotics 9:42

    Article  Google Scholar 

  8. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH (2009) Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13:275–281

    Article  PubMed  Google Scholar 

  9. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860

    Article  PubMed  Google Scholar 

  11. Foo CC, Law WL (2016) The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg 40:456–462

    Article  PubMed  Google Scholar 

  12. Jimenez-Rodriguez RM, Diaz-Pavon JM, Portilla de Juan FDL, Prendes-Sillero E, Dussort HC, Padillo J (2013) Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 28:815–821

    Article  PubMed  Google Scholar 

  13. Kim HJ, Choi GS, Park JS, Park SY (2014) Multidimensional analysis of the learning curve for robotic total mesorectal excision for rectal cancer: lessons from a single surgeon’s experience. Dis Colon Rectum 57:1066–1074

    Article  PubMed  Google Scholar 

  14. Kim YW, Lee HM, Kim NK, Min BS, Lee KY (2012) The learning curve for robot-assisted total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech 22:400–405

    Article  PubMed  Google Scholar 

  15. Park EJ, Kim CW, Cho MS, Baik SH, Kim DW, Min BS et al (2014) Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28:2821–2831

    Article  PubMed  Google Scholar 

  16. Park EJ, Kim CW, Cho MS, Kim DW, Min BS, Baik SH et al (2014) Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer?: a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries. Medicine (Baltimore) 93:e109

    Article  PubMed  Google Scholar 

  17. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2011) S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25:240–248

    Article  PubMed  Google Scholar 

  18. Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH (2013) The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27:3297–3307

    Article  PubMed  Google Scholar 

  19. Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H et al (2015) Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29:1679–1685

    Article  PubMed  Google Scholar 

  20. Gachabayov M, You K, Kim SH, Yamaguchi T, Jimenez-Rodriguez R, Kuo LJ et al (2019) Meta-analysis of the impact of the learning curve in robotic rectal cancer surgery on histopathologic outcomes. Surg Technol Int 34:139–155

    PubMed  Google Scholar 

  21. Huang YM, Huang YJ, Wei PL (2017) Outcomes of robotic versus laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiation therapy and the effect of learning curve. Medicine (Baltimore) 96:e8171

    Article  PubMed  Google Scholar 

  22. Kuo LJ, Lin YK, Chang CC, Tai CJ, Chiou JF, Chang YJ (2014) Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis 29:555–562

    Article  PubMed  Google Scholar 

  23. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349

    Article  Google Scholar 

  24. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  25. Gomez Ruiz M, Ballestero Diego R, Tejedor P, Cagigas Fernandez C, Cristobal Poch L, Suarez Pazos N et al (2023) Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality. Updates Surg 75:589–597

    Article  PubMed  Google Scholar 

  26. Feng Q, Yuan W, Li T, Tang B, Jia B, Zhou Y et al (2022) Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 7:991–1004

    Article  PubMed  Google Scholar 

  27. Abdel-Misih SR, Wei L, Benson AB 3rd, Cohen S, Lai L, Skibber J et al (2016) Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome: the case for eliminating a metric and using preoperative staging to guide therapy. J Natl Compr Canc Netw 14:1528–1534

    Article  PubMed  PubMed Central  Google Scholar 

  28. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251:807–818

    Article  PubMed  Google Scholar 

  29. Matsuyama T, Kinugasa Y, Nakajima Y, Kojima K (2018) Robotic-assisted surgery - current state of the art and future perspective colorectal cancer. Gan To Kagaku Ryoho 45:1696–1700

    PubMed  Google Scholar 

  30. Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC (2012) Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 19:2095–2101

    Article  PubMed  Google Scholar 

  31. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A et al (2018) Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 267:1034–1046

    Article  PubMed  Google Scholar 

  32. Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F et al (2012) Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis 14:e134-156

    Article  CAS  PubMed  Google Scholar 

  33. Balla A, Saraceno F, Rullo M, Morales-Conde S, Targarona Soler EM, Di Saverio S et al (2023) Protective ileostomy creation after anterior resection of the rectum: shared decision-making or still subjective? Colorectal Dis 25:647–659

    Article  PubMed  Google Scholar 

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Acknowledgements

Authors have omitted this information to respect the blinded manuscript format.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Rafael Calleja and Francisco Javier Medina-Fernández have contributed equally to this work.

Authors and Affiliations

  1. General and Digestive Surgery Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n 14004, Cordoba, Spain

    Rafael Calleja, Francisco Javier Medina-Fernández, Ana Vallejo-Lesmes, Manuel Durán, Eva M. Torres-Tordera, César A. Díaz-López & Javier Briceño

  2. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain

    Rafael Calleja, Francisco Javier Medina-Fernández, Manuel Durán, César A. Díaz-López & Javier Briceño

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  1. Rafael Calleja
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  3. Ana Vallejo-Lesmes
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Contributions

Study design: RCL, MDM, FJMF. Manuscript writing: RCL, AVL, FJMF. Data acquisition (Surgeons): CADL, FJMF, EMTT. Critical review: FJMF, FJBD.

Corresponding author

Correspondence to Rafael Calleja.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval, Research involving human participants and/or animals, and Informed consent

This research involves data from human subjects. All conducted procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.

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Calleja, R., Medina-Fernández, F., Vallejo-Lesmes, A. et al. Transition from laparoscopic to robotic approach in rectal cancer: a single-center short-term analysis based on the learning curve. Updates Surg 75, 2179–2189 (2023). https://doi.org/10.1007/s13304-023-01655-9

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  • DOI: https://doi.org/10.1007/s13304-023-01655-9

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