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Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer

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Abstract

Robotic surgery is increasingly used in the field of rectal cancer surgery. This study aimed to compare the short- and long-term outcomes between robotic and laparoscopic ultralow anterior resection (uLAR) and coloanal anastomosis (CAA). Between January 2007 and December 2010, a retrospective chart review was performed for all patients with low rectal cancer who underwent curative uLAR and CAA with or without intersphincteric resection using either a robotic or a laparoscopic approach. The study excluded patients with tumors invading the levator ani or external sphincter, patients with T4 cancers invading the prostate or vagina, and patients for whom an open approach was used. Patients’ short- and long-term outcomes were evaluated. This study enrolled 84 consecutive patients (47 in the robotic group and 37 in the laparoscopic group). The patient characteristics and operative data did not differ significantly between the groups except for the rate of conversion to open surgery (robot, 2.1 % vs laparoscopy, 16.2 %; p = 0.02). The postoperative outcomes also were similar in the two groups, but the hospital stay was shorter in the robotic group than in the laparoscopic group (robot, 9 days vs laparoscopy, 11 days; p = 0.011). No postoperative mortality occurred. The median follow-up period was 31.5 months. No difference was shown in local recurrence, 3-year overall survival, or disease-free survival between the two groups. Robotic uLAR and CAA with or without ISR is a safe and feasible surgical approach with a lower conversion rate, a shorter hospital stay, and similar oncologic outcomes compared with a laparoscopic approach. Further prospective and case–control cohort studies with longer follow-up periods are required.

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References

  1. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, Cohen AM, Guillem JG (2003) Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 10:80–85

    Article  PubMed  Google Scholar 

  2. Dahlberg M, Glimelius B, Pahlman L (1999) Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 86:379–384

    Article  PubMed  CAS  Google Scholar 

  3. Fischer A, Tarantino I, Warschkow R, Lange J, Zerz A, Hetzer FH (2010) Is sphincter preservation reasonable in all patients with rectal cancer? Int J Colorectal Dis 25:425–432

    Article  PubMed  Google Scholar 

  4. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81:1376–1378

    Article  PubMed  CAS  Google Scholar 

  5. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC Clasicc trial group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  6. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  7. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the cost study group trial. Ann Surg 246:655–662 discussion 662–654

    Article  PubMed  Google Scholar 

  8. Alasari S, Min BS (2012) Robotic colorectal surgery: a systematic review. ISRN Surg. doi:10.5402/2012/293894

    PubMed  Google Scholar 

  9. Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694 discussion 1695–1686

    Article  PubMed  Google Scholar 

  10. Dakin GF, Gagner M (2003) Comparison of laparoscopic skills performance between standard instruments and two surgical robotic systems. Surg Endosc 17:574–579

    Article  PubMed  CAS  Google Scholar 

  11. Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Buchler MW (2004) Robot-assisted abdominal surgery. Br J Surg 91:1390–1397

    Article  PubMed  CAS  Google Scholar 

  12. Patel VR, Chammas MF Jr, Shah S (2007) Robotic-assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract 61:309–314

    Article  PubMed  CAS  Google Scholar 

  13. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14–21

    Article  PubMed  Google Scholar 

  14. Leong QM, Son DN, Cho JS, Baek SJ, Kwak JM, Amar AH, Kim SH (2011) Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc 25:2987–2992

    Article  PubMed  Google Scholar 

  15. Kang J, Hur H, Min BS, Lee KY, Kim NK (2012) Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer: starting with the perianal approach followed by robotic procedure. Ann Surg Oncol 19:154–155

    Article  PubMed  Google Scholar 

  16. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

    PubMed  CAS  Google Scholar 

  17. Park YA, Kim JM, Kim SA, Min BS, Kim NK, Sohn SK, Lee KY (2010) Totally robotic surgery for rectal cancer: from splenic flexure to pelvic floor in one setup. Surg Endosc 24:715–720

    Article  PubMed  Google Scholar 

  18. Park JS, Choi GS, Jun SH, Hasegawa S, Sakai Y (2011) Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg 254:941–946

    Article  PubMed  Google Scholar 

  19. Fujimoto Y, Akiyoshi T, Kuroyanagi H, Konishi T, Ueno M, Oya M, Yamaguchi T (2010) Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg 14:645–650

    Article  PubMed  Google Scholar 

  20. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451

    Article  PubMed  CAS  Google Scholar 

  21. Strohlein MA, Grutzner KU, Jauch KW, Heiss MM (2008) Comparison of laparoscopic vs open access surgery in patients with rectal cancer: a prospective analysis. Dis Colon Rectum 51:385–391

    Article  PubMed  Google Scholar 

  22. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP (2012) Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc 27:48–55

    Article  PubMed  Google Scholar 

  23. Kapiteijn E, Kranenbarg EK, Steup WH, Taat CW, Rutten HJ, Wiggers T, van Krieken JH, Hermans J, Leer JW, van de Velde CJ (1999) Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer: prospective randomised trial with standard operative and histopathological techniques. Dutch Colorectal Cancer Group. Eur J Surg 165:410–420

    Article  PubMed  CAS  Google Scholar 

  24. Leonard D, Penninckx F, Fieuws S, Jouret-Mourin A, Sempoux C, Jehaes C, Van Eycken E (2010) Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg 252:982–988

    Article  PubMed  Google Scholar 

  25. Maslekar S, Sharma A, Macdonald A, Gunn J, Monson JR, Hartley JE (2007) Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum 50:168–175

    Article  PubMed  Google Scholar 

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Disclosures

Se Jin Baek, Sami AL-Asari, Duck Hyoun Jeong, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, and Nam Kyu Kim have no conflicts of interest or financial ties to disclose.

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Correspondence to Sami AL-Asari.

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Baek, S.J., AL-Asari, S., Jeong, D.H. et al. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc 27, 4157–4163 (2013). https://doi.org/10.1007/s00464-013-3014-4

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  • DOI: https://doi.org/10.1007/s00464-013-3014-4

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