Surgical Endoscopy

, Volume 24, Issue 11, pp 2888–2894 | Cite as

Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes

  • P. P. Bianchi
  • C. Ceriani
  • A. Locatelli
  • G. Spinoglio
  • M. G. Zampino
  • A. Sonzogni
  • C. Crosta
  • B. Andreoni
Article

Abstract

Background

We assessed feasibility, short-term oncologic safety, and short-term outcomes in robotic total mesorectal excision (R-TME) for rectal cancer compared with laparoscopic TME.

Methods

From March 2008 to June 2009, 50 patients with proven middle/lower rectal adenocarcinoma underwent minimally invasive TME; 25 received R-TME. The groups were balanced (R-TME versus L-TME) in terms of age (median 69 versus 62 years; p = 0.8), disease stage, and body mass index (median 23 versus 26.5 kg/m2; p = 0.06). There were 37 (74%) anterior resections and 13 (26%) abdominoperineal resections. Twenty-three (46%) patients received preoperative radiochemotherapy. The robot was a four-arm Da Vinci S (Intuitive Surgical, Sunnyvale, CA, USA).

Results

Median operating time (R-TME versus L-TME) was 240 versus 237 min (p = 0.2); first bowel movement was 2 versus 3 days (p = 0.5); median hospital stay was 6.5 versus 6 days (p = 0.4). Major complications with reoperation were two in R-TME (one anastomotic leakage, one small bowel perforation) and three in L-TME (one colonic ischemia, two anastomotic leakage). Postoperative complications were 16% versus 24% (p = 0.5). A median of 18 versus 17 (p = 0.7) lymph nodes were retrieved; distal resection margins were disease free in both groups; circumferential margin was involved (<1.0 mm) in one (4%) of L-TME. There were 0 versus 1 (5%) conversions to laparotomy.

Conclusions

R-TME in rectal cancer is feasible, with short-term oncologic and other outcomes similar to those of L-TME. The greater maneuverability and visibility afforded by the robotic approach are attractive. Future studies should more systematically address advantages and costs of R-TME.

Keywords

Rectal cancer Laparoscopic surgery Total mesorectal excision Robotic surgery Laparoscopic rectal resection Robotic rectal resection 

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • P. P. Bianchi
    • 1
  • C. Ceriani
    • 1
  • A. Locatelli
    • 1
  • G. Spinoglio
    • 2
  • M. G. Zampino
    • 3
  • A. Sonzogni
    • 4
  • C. Crosta
    • 5
  • B. Andreoni
    • 1
  1. 1.Unit of Minimally Invasive Surgery, Division of General and Laparoscopic SurgeryEuropean Institute of Oncology, University of MilanMilanoItaly
  2. 2.Department of SurgerySS Antonio e Biagio HospitalAlessandriaItaly
  3. 3.Division of Medical OncologyEuropean Institute of OncologyMilanoItaly
  4. 4.Division of PathologyEuropean Institute of Oncology, University of MilanMilanoItaly
  5. 5.Division of EndoscopyEuropean Institute of OncologyMilanoItaly

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