Skip to main content

Advertisement

SpringerLink
Log in

Systematic review of robotic low anterior resection for rectal cancer

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Potential advantages of robotic surgery, such as 3-dimensional high-definition vision, wrist-like movements of instruments, stable camera holding, motion filter for tremor-free surgery, and improved ergonomics, may provide better clinical, oncological, and functional outcomes in rectal cancer surgery, as suggested in many comparative studies. However, there has not been a systematic review specific to LAR/TME for rectal cancer that includes both robotic versus laparoscopic and robotic versus open comparative studies.

Methods

The PubMed and Scopus databases were systematically searched in a two-step process, first for all robotic publications, and then within those results, for studies that compared perioperative, oncologic, or functional outcomes of robotic versus laparoscopic or open LAR/TME. Randomized controlled trials, systematic reviews, and independent database population studies were included in the analysis.

Results

Thirteen publications reporting on 24,526 patients met the inclusion criteria. Two studies compared robotic and open surgery, ten compared robotic and laparoscopic surgery, and one study compared all three. Robotic surgery resulted in increased operating times, reduced blood loss, fewer transfusions, shorter hospital stay, and comparable oncologic outcomes versus open surgery, and reduced conversion and impotency rates versus laparoscopic surgery.

Conclusions

Robotic surgery is comparable to open and laparoscopic surgery concerning oncologic outcomes and seems to provide some clinical and functional benefits, although evidence is limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  2. Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  CAS  PubMed  Google Scholar 

  3. Pigazzi A, Ellenhorn JD, Ballantyne GH et al (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  CAS  PubMed  Google Scholar 

  4. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22:1601–1608

    Article  CAS  PubMed  Google Scholar 

  5. Broholm M, Pommergaard HC, Gogenur I (2015) Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis 17:375–381

    Article  CAS  PubMed  Google Scholar 

  6. Lee SH, Lim S, Kim JH et al (2015) Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 89:190–201

    Article  PubMed  PubMed Central  Google Scholar 

  7. Liao G, Li YB, Zhao Z et al (2016) Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Sci Rep 6:26981

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lin S, Jiang HG, Chen ZH et al (2011) Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol 17:5214–5220

    Article  PubMed  PubMed Central  Google Scholar 

  9. Memon S, Heriot AG, Murphy DG et al (2012) Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 19:2095–2101

    Article  PubMed  Google Scholar 

  10. Midura EF, Hanseman DJ, Hoehn RS et al (2015) The effect of surgical approach on short-term oncologic outcomes in rectal cancer surgery. Surgery 158:453–459

    Article  PubMed  Google Scholar 

  11. Somashekhar SP, Ashwin KR, Rajashekhar J et al (2015) Prospective randomized study comparing robotic-assisted surgery with traditional laparotomy for rectal cancer-Indian study. Indian J Surg 77:788–794

    Article  CAS  PubMed  Google Scholar 

  12. Sun Y, Xu H, Li Z et al (2016) Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 14:61

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sun Z, Kim J, Adam MA et al (2016) Minimally invasive versus open low anterior resection: equivalent survival in a national analysis of 14,033 patients with rectal cancer. Ann Surg 263:1152–1158

    Article  PubMed  Google Scholar 

  14. Trastulli S, Farinella E, Cirocchi R 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–e156

    Article  CAS  PubMed  Google Scholar 

  15. Xiong B, Ma L, Huang W et al (2015) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19:516–526

    Article  PubMed  Google Scholar 

  16. Yang Y, Wang F, Zhang P et al (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19:3727–3736

    Article  PubMed  Google Scholar 

  17. Gonzalez Fernandez AM, Mascarenas Gonzalez JF (2012) Total laparoscopic mesorectal excision versus robot-assisted in the treatment of rectal cancer: a meta-analysis. Cir Esp 90:348–354

    Article  PubMed  Google Scholar 

  18. Wang M, Kang X, Wang H et al (2014) A meta-analysis on the outcomes and potential benefits of hybrid robotic technique in rectal cancer surgery. Zhonghua Wei Chang Wai Ke Za Zhi 17:785–790

    PubMed  Google Scholar 

  19. Yuan DB, Wen XN, Xu XC et al (2012) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. World Chinese J Digestol 20:3804–3810

    Article  Google Scholar 

  20. Gleitsmann K, Bunker K, Kriz H et al (2012) Robotic assisted surgery. Center for Evidence-based Policy, Oregon Health and Science University, Portland, pp 1–422

    Google Scholar 

  21. Damle RN, Flahive JM, Davids JS et al (2016) Examination of racial disparities in the receipt of minimally invasive surgery among a national cohort of adult patients undergoing colorectal surgery. Dis Colon Rectum 59:1055–1062

    Article  PubMed  Google Scholar 

  22. Patel SV, Van Koughnett JA, Howe B et al (2015) Spin is common in studies assessing robotic colorectal surgery: an assessment of reporting and interpretation of study results. Dis Colon Rectum 58:878–884

    Article  PubMed  Google Scholar 

  23. Schootman M, Hendren S, Ratnapradipa K et al (2016) Adoption of robotic technology for treating colorectal cancer. Dis Colon Rectum 59:1011–1018

    Article  PubMed  PubMed Central  Google Scholar 

  24. Turner M, Adam MA, Sun Z et al. Insurance status, not race, is associated with use of minimally invasive surgical approach for rectal cancer. Ann Surg. 2016

  25. Yeo HL, Abelson JS, Mao J et al (2016) Minimally invasive surgery and sphincter preservation in rectal cancer. J Surg Res 202:299–307

    Article  PubMed  Google Scholar 

  26. Dolejs SC, Waters JA, Ceppa EP et al. Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc. 2016

  27. Bhama AR, Obias V, Welch KB et al (2016) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 30:1576–1584

    Article  PubMed  Google Scholar 

  28. Hollis RH, Cannon JA, Singletary BA et al (2016) Understanding the value of both laparoscopic and robotic approaches compared to the open approach in colorectal surgery. J Laparoendosc Adv Surg Tech A 26:850–856

    Article  PubMed  Google Scholar 

  29. Jimenez Rodriguez RM, Diaz Pavon JM, de La Portilla de Juan F et al (2011) Prospective randomised study: robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection. Cir Esp 89:432–438

    Article  PubMed  Google Scholar 

  30. Kockerling F (2014) Robotic vs. standard laparoscopic technique: what is better? Front Surg 1:15

    PubMed  PubMed Central  Google Scholar 

  31. Liao G, Zhao Z, Lin S et al (2014) Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol 12:122

    Article  PubMed  PubMed Central  Google Scholar 

  32. Maeso S, Reza M, Mayol JA et al (2010) Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg 252:254–262

    Article  PubMed  Google Scholar 

  33. Salman M, Bell T, Martin J et al (2013) Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg 79:553–560

    PubMed  Google Scholar 

  34. Tan A, Ashrafian H, Scott AJ et al (2016) Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc 30:4330–4352

    Article  PubMed  PubMed Central  Google Scholar 

  35. Trinh BB, Jackson NR, Hauch AT et al (2014) Robotic versus laparoscopic colorectal surgery. JSLS 18:e2014.00187

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yu J, Wang Y, Li Y et al (2014) The safety and effectiveness of Da Vinci surgical system compared with open surgery and laparoscopic surgery: a rapid assessment. J Evid Based Med 7:121–134

    Article  PubMed  Google Scholar 

  37. Zhang X, Wei Z, Bie M et al (2016) Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 30:5601–5614

    Article  PubMed  Google Scholar 

  38. Addae JK, Gani F, Fang SY et al (2017) A comparison of trends in operative approach and postoperative outcomes for colorectal cancer surgery. J Surg Res 208:111–120

    Article  PubMed  Google Scholar 

  39. Bhama AR, Wafa AM, Ferraro J et al (2016) Comparison of risk factors for unplanned conversion from laparoscopic and robotic to open colorectal surgery using the Michigan surgical quality collaborative (MSQC) database. J Gastrointest Surg 20:1223–1230

    Article  PubMed  Google Scholar 

  40. Feinberg AE, Elnahas A, Bashir S et al (2016) Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity. Can J Surg 59:16615

    Article  Google Scholar 

  41. Gabriel E, Thirunavukarasu P, Al-Sukhni E et al (2016) National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 30:1060–1067

    Article  PubMed  Google Scholar 

  42. Keller DS, Senagore AJ, Lawrence JK et al (2014) Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 28:212–221

    Article  PubMed  Google Scholar 

  43. Lorenzon L, Bini F, Balducci G et al (2016) Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis. Int J Colorectal Dis 31:161–173

    Article  PubMed  Google Scholar 

  44. Tam MS, Kaoutzanis C, Mullard AJ et al (2016) A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. Surg Endosc 30:455–463

    Article  PubMed  Google Scholar 

  45. Collinson FJ, Jayne DG, Pigazzi A et al (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 27:233–241

    Article  PubMed  Google Scholar 

  46. Fazl Alizadeh R, Stamos MJ (2016) Minimally invasive surgery for rectal cancer. Minerva Chir 71:311–321

    PubMed  Google Scholar 

  47. Guerra F, Pesi B, Amore Bonapasta S et al (2016) Does robotics improve minimally invasive rectal surgery? Functional and oncological implications. J Dig Dis 17:88–94

    Article  PubMed  Google Scholar 

  48. Speicher PJ, Englum BR, Ganapathi AM et al (2015) Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg 262:1040–1045

    Article  PubMed  Google Scholar 

  49. Ortiz-Oshiro E, Sanchez-Egido I, Moreno-Sierra J et al (2012) Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis. Int J Med Robot 8:360–370

    Article  PubMed  Google Scholar 

  50. Wang Y, Zhao GH, Yang H et al (2016) A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech 26:259–264

    Article  PubMed  Google Scholar 

  51. Xiong B, Ma L, Zhang C et al (2014) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res 188:404–414

    Article  PubMed  Google Scholar 

  52. Chen SH, Li ZA, Huang R et al (2016) Robot-assisted versus conventional laparoscopic surgery for endometrial cancer staging: a meta-analysis. Taiwan J Obstet Gynecol 55:488–494

    Article  PubMed  Google Scholar 

  53. Choi JE, You JH, Kim DK et al (2015) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67:891–901

    Article  PubMed  Google Scholar 

  54. Laird A, Fowler S, Good DW et al (2015) Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: a report of national outcomes. BJU Int 115:753–763

    Article  PubMed  Google Scholar 

  55. Park DA, Yun JE, Kim SW et al (2016) Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: a systematic review and meta-analysis. Eur J Surg Oncol. 43:994

    Article  PubMed  Google Scholar 

  56. Weiner AB, Murthy P, Richards KA et al (2015) Population based analysis of incidence and predictors of open conversion during minimally invasive radical prostatectomy. J Urol 193:826–831

    Article  PubMed  Google Scholar 

  57. Xie W, Cao D, Yang J et al (2016) Robot-assisted surgery versus conventional laparoscopic surgery for endometrial cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 142:2173–2183

    Article  PubMed  Google Scholar 

  58. Franks PJ, Bosanquet N, Thorpe H et al (2006) Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95:6–12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Yamamoto S, Fukunaga M, Miyajima N et al (2009) Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients. J Am Coll Surg 208:383–389

    Article  PubMed  Google Scholar 

  60. Rottoli M, Bona S, Rosati R et al (2009) Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival. Ann Surg Oncol 16:1279–1286

    Article  PubMed  Google Scholar 

  61. Masui H, Ike H, Yamaguchi S et al (1996) Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum 39:1140–1145

    Article  CAS  PubMed  Google Scholar 

  62. Pigazzi A Early ROLARR results: implications for MIS rectal cancer surgery. Presentation at the PG Course: getting behind advances in colorectal surgery during the SAGES 2016 Annual Meeting, Boston MA, 2016. https://www.sages.org/video/early-rolarr-results-implications-for-mis-rectal-cancer-surgery. Accessed 15 Oct 2017

  63. Dulskas A, Miliauskas P, Tikuisis R et al (2016) The functional results of radical rectal cancer surgery: review of the literature. Acta Chir Belg 116(1):1–10

    Article  PubMed  Google Scholar 

  64. Hughes DL, Cornish J, Morris C, LARRIS Trial Management Group (2017) Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome. Int J Colorectal Dis 32(5):691–697

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

April E Hebert, PhD, a scientific consultant, provided technical help in the form of searching the robotic literature library and performing data abstraction.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Christoph Holmer & Martin E. Kreis

Authors
  1. Christoph Holmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin E. Kreis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Holmer.

Ethics declarations

Disclosures

Drs. Holmer and Kreis have the following conflict: The consultant who searched the robotic literature library and performed data abstraction was paid by Intuitive Surgical (Sunnyvale, CA), the manufacturer of the “Da Vinci” Surgical System.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holmer, C., Kreis, M.E. Systematic review of robotic low anterior resection for rectal cancer. Surg Endosc 32, 569–581 (2018). https://doi.org/10.1007/s00464-017-5978-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5978-y

Keywords

Search

Navigation