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. BianchiEmail author
  • C. Ceriani
  • A. Locatelli
  • G. Spinoglio
  • M. G. Zampino
  • A. Sonzogni
  • C. Crosta
  • B. Andreoni



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.


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).


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.


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.


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



The authors thank Darina Tamayo for help in the preparation and Don Ward for help with English.


Authors Paolo Pietro Bianchi, Chiara Ceriani, Andrea Locatelli, Giuseppe Spinoglio, Maria Giulia Zampino, Angelica Sonzogni, Cristiano Crosta, and Bruno Andreoni have no conflicts of interest or financial ties to disclose.


  1. 1.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059CrossRefGoogle Scholar
  2. 2.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMedGoogle Scholar
  3. 3.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) COlon cancer Laparoscopic or Open Resection (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484CrossRefPubMedGoogle Scholar
  4. 4.
    Read TE (2007) Laparoscopic proctectomy for rectal adenocarcinoma. J Surg Oncol 96(8):660–664Google Scholar
  5. 5.
    Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237(3):335–342CrossRefPubMedGoogle Scholar
  6. 6.
    Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 18(4):CD005200Google Scholar
  7. 7.
    Barlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19(6):757–766CrossRefPubMedGoogle Scholar
  8. 8.
    Bretagnol F, Lelong B, Laurent C, Moutardier V, Rullier A, Monges G, Delpero JR, Rullier E (2005) The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 19(7):892–896CrossRefPubMedGoogle Scholar
  9. 9.
    Bianchi PP, Rosati R, Bona S, Rottoli M, Elmore U, Ceriani C, Malesci A, Montorsi M (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50(12):2047–2053CrossRefPubMedGoogle Scholar
  10. 10.
    Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14(11):3168–3173CrossRefPubMedGoogle Scholar
  11. 11.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20(10):1521–1525CrossRefPubMedGoogle Scholar
  12. 12.
    Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16(6):1480–1487CrossRefPubMedGoogle Scholar
  13. 13.
    Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51(11):1627–1632CrossRefPubMedGoogle Scholar
  14. 14.
    Ng KH, Lim YK, Ho KS, Ooi BS, Eu KW (2009) Robotic-assisted surgery for low rectal dissection: from better views to better outcome. Singapore Med J 50(8):763–767PubMedGoogle Scholar
  15. 15.
    Luca F, Cenciarelli S, Valvo M, Pozzi S, Faso FL, Ravizza D, Zampino G, Sonzogni A, Biffi R (2009) Full robotic left colon and rectal cancer resection: technique and early outcome. Ann Surg Oncol 16(5):1274–1278CrossRefPubMedGoogle Scholar
  16. 16.
    Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18(2):281–289CrossRefPubMedGoogle Scholar
  17. 17.
    Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250(1):54–61CrossRefPubMedGoogle Scholar
  18. 18.
    Law WL, Poon JT, Fan JK, Lo SH (2009) Comparison of outcome of open and laparoscopic resection for stage II and stage III rectal cancer. Ann Surg Oncol 16(6):1488–1493CrossRefPubMedGoogle Scholar
  19. 19.
    Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52(4):558–566PubMedGoogle Scholar
  20. 20.
    Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96(9):982–989CrossRefPubMedGoogle Scholar
  21. 21.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25(21):3061–3068CrossRefPubMedGoogle Scholar
  22. 22.
    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(2):275–281CrossRefPubMedGoogle Scholar
  23. 23.
    Tjandra JJ, Chan MK, Yeh CH (2008) Laparoscopic- vs hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 51(1):26–31CrossRefPubMedGoogle Scholar
  24. 24.
    Coelho RF, Chauhan S, Palmer KJ, Rocco B, Patel MB, Patel VR (2009) Robotic-assisted radical prostatectomy: a review of current outcomes. BJU Int 104(10):1428–1435CrossRefPubMedGoogle Scholar
  25. 25.
    Rottoli M, Bona S, Rosati R, Elmore U, Bianchi PP, Spinelli A, Bartolucci C, Montorsi M (2009) Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival. Ann Surg Oncol 16(5):1279–1286CrossRefPubMedGoogle Scholar
  26. 26.
    Hellan M, Stein H, Pigazzi A (2009) Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. Surg Endosc 23(2):447–451CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • P. P. Bianchi
    • 1
    Email author
  • 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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