Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcomes of upfront robotic rectal cancer surgery: a single-center, retrospective cohort study in Japan

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the long-term outcomes of robotic rectal cancer surgery and to examine the risk factors for recurrence.

Methods

In a high-volume center in Japan, we retrospectively enrolled patients with pStage I–III rectal cancer within 15 cm of the anal verge who underwent robotic surgery from 2011 to 2017. Almost all patients underwent upfront surgery, and lateral lymph-node dissection (LLND) was performed for patients with locally advanced lower rectal cancer. We evaluated the 5-year overall survival (OS), relapse-free survival (RFS), and cumulative local recurrence (LR) rates and examined the risk factors for the RFS.

Results

We evaluated 488 patients who underwent robotic rectal cancer surgery, including 5.1% who underwent preoperative chemoradiotherapy to obtain clear resection margins and 33.6% who underwent LLND. There were 203, 87, and 198 patients with pStage I, II, and III, respectively, and the positive resection margin rate was 1.0%. The 5-year OS, RFS, and LR rates were 95.5%, 81.7%, and 2.2%, respectively. The independent risk factors for the RFS were the presence of venous invasion, extramural tumor deposits without lymph-node structure, and pT ≥ 3.

Conclusion

This study demonstrated the favorable long-term outcomes of robotic rectal cancer surgery.

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
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.

    Article  CAS  PubMed  Google Scholar 

  2. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg. 2019;269:596–602.

    Article  PubMed  Google Scholar 

  3. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage ii to iii rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;269:589–95.

    Article  PubMed  Google Scholar 

  4. Broholm M, Pommergaard H-C, Gögenür I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis. 2015;17:375–81.

    Article  CAS  PubMed  Google Scholar 

  5. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267:1034–46.

    Article  PubMed  Google Scholar 

  6. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318:1569–80.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kim MJ, Park SC, Park JW, Chang HJ, Kim DY, Nam B-H, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase ii open label prospective randomized controlled trial. Ann Surg. 2018;267:243–51.

    Article  PubMed  Google Scholar 

  8. Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg. 2015;261:129–37.

    Article  PubMed  Google Scholar 

  9. Kim J, Baek S-J, Kang D-W, Roh Y-E, Lee JW, Kwak H-D, et al. Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum. 2017;60:266–73.

    Article  PubMed  Google Scholar 

  10. Sammour T, Malakorn S, Bednarski BK, Kaur H, Shin US, Messick C, et al. Oncological outcomes after robotic proctectomy for rectal cancer: analysis of a prospective database. Ann Surg. 2018;267:521–6.

    Article  PubMed  Google Scholar 

  11. Chang W, Wei Y, Ren L, Jian M, Chen Y, Chen J, et al. Short-term and long-term outcomes of robotic rectal surgery-from the real word data of 1145 consecutive cases in China. Surg Endosc. 2020;34:4079–88.

    Article  PubMed  Google Scholar 

  12. Tilney HS, Huddy JR, Nizar AS, Smith R, Gudgeon AM. Minimal access rectal cancer surgery: an observational study of patient outcomes from a district general hospital with over a decade of experience with robotic rectal cancer surgery. Colorectal Dis. 2021;23:1961–70.

    Article  PubMed  Google Scholar 

  13. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42.

    Article  PubMed  Google Scholar 

  14. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28:iv22–40.

    Article  CAS  PubMed  Google Scholar 

  15. Benson AB, Venook AP, Al-Hawary MH, Arain MA, Chen Y-J, Ciombor KK, et al. NCCN guidelines insights: rectal cancer, version 6.2020. J Natl Compr Canc Netw. 2020;18:806–15.

    Article  PubMed  Google Scholar 

  16. Cercek A, Roxburgh CSD, Strombom P, Smith JJ, Temple LKF, Nash GM, et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol. 2018;4: e180071.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furuatni A, et al. Short- and long-term outcomes of robotic-assisted laparoscopic surgery for rectal cancer: results of a single high-volume center in Japan. Int J Colorectal Dis. 2018;33:1755–62.

    Article  PubMed  Google Scholar 

  18. Brierley JD, Gorley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. Hoboken: Wiley-Blackwell; 2017.

    Google Scholar 

  19. Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K, et al. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg. 2012;255:1129–34.

    Article  PubMed  Google Scholar 

  20. Ueno H, Mochizuki H, Shirouzu K, Kusumi T, Yamada K, Ikegami M, et al. Multicenter study for optimal categorization of extramural tumor deposits for colorectal cancer staging. Ann Surg. 2012;255:739–46.

    Article  PubMed  Google Scholar 

  21. Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H. Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Colorectal Dis. 2014;29:1105–11.

    Article  PubMed  Google Scholar 

  22. Kasai S, Kagawa H, Shiomi A, Hino H, Manabe S, Yamaoka Y, et al. Advantages of robotic abdominoperineal resection compared with laparoscopic surgery: a single-center retrospective study. Surg Today. 2022;52(4):643–51.

    Article  PubMed  Google Scholar 

  23. Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kato S, et al. Robotic surgery for clinical T4 rectal cancer: short- and long-term outcomes. Surg Endosc. 2022;36:91–9.

    Article  PubMed  Google Scholar 

  24. Kagawa H, Kinugasa Y, Shiomi A, Yamaguchi T, Tsukamoto S, Tomioka H, et al. Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surg Endosc. 2015;29:995–1000.

    Article  PubMed  Google Scholar 

  25. Hino H, Shiomi A, Kagawa H, Manabe S, Yamaoka Y, Kato S, et al. Neoadjuvant chemoradiotherapy for borderline resectable low rectal cancer: short- and long-term outcomes at a single Japanese center. Surg Today. 2022. https://doi.org/10.1007/s00595-021-02419-x,January8.

    Article  PubMed  Google Scholar 

  26. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  27. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    Article  CAS  Google Scholar 

  28. Park SY, Lee SM, Park JS, Kim HJ, Choi G-S. Robot surgery shows similar long-term oncologic outcomes as laparoscopic surgery for mid/lower rectal cancer but is beneficial to ypT3/4 after preoperative chemoradiation. Dis Colon Rectum. 2021;64:812–21.

    Article  PubMed  Google Scholar 

  29. van Gijn W, Marijnen CAM, Nagtegaal ID, Kranenbarg EM-K, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicenter, randomised controlled TME trial. Lancet Oncol. 2011;12:575–82.

    Article  PubMed  Google Scholar 

  30. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30:1926–33.

    Article  CAS  PubMed  Google Scholar 

  31. Ogura A, Konishi T, Cunningham C, Garcia-Aguilar J, Iversen H, Toda S, et al. Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter Lateral Node Study of patients with low cT3/4 rectal cancer. J Clin Oncol. 2019;37:33–43.

    Article  CAS  PubMed  Google Scholar 

  32. Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012;13:616–21.

    Article  PubMed  Google Scholar 

  33. Tsukamoto S, Fujita S, Ota M, Mizusawa J, Shida D, Kanemitsu Y, et al. Long-term follow-up of the randomized trial of mesorectal excision with or without lateral lymph node dissection in rectal cancer (JCOG0212). Br J Surg. 2020;107:586–94.

    Article  CAS  PubMed  Google Scholar 

  34. Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H. Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc. 2016;30:721–8.

    Article  PubMed  Google Scholar 

  35. Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furutani A, et al. Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc. 2018;32:4498–505.

    Article  PubMed  Google Scholar 

  36. Peacock O, Limvorapitak T, Bednarski BK, Kaur H, Taggart MW, Dasari A, et al. Robotic lateral pelvic lymph node dissection after chemoradiation for rectal cancer: a Western perspective. Colorectal Dis. 2020;22:2049–56.

    Article  CAS  PubMed  Google Scholar 

  37. Marijnen CAM, van de Velde CJH, Putter H, van den Brink M, Maas CP, Martijn H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005;23:1847–58.

    Article  PubMed  Google Scholar 

  38. Peeters KCMJ, van de Velde CJH, Leer JWH, Martijn H, Junggeburt JMC, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients–a Dutch colorectal cancer group study. J Clin Oncol. 2005;23:6199–206.

    Article  CAS  PubMed  Google Scholar 

  39. Chand M, Siddiqui MRS, Swift I, Brown G. Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol. 2016;22:1721–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Nagtegaal ID, Knijn N, Hugen N, Marshall HC, Sugihara K, Tot T, et al. Tumor deposits in colorectal cancer: improving the value of modern staging-a systematic review and meta-analysis. J Clin Oncol. 2017;35:1119–27.

    Article  PubMed  Google Scholar 

  41. Lord AC, DʼSouza N, Shaw A, Rokan Z, Moran B, Abulafi M, et al. MRI-diagnosed tumour deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer. Ann Surg. 2020. https://doi.org/10.1097/SLA.0000000000004499.

    Article  PubMed  Google Scholar 

  42. Lord AC, Knijn N, Brown G, Nagtegaal ID. Pathways of spread in rectal cancer: a reappraisal of the true routes to distant metastatic disease. Eur J Cancer. 2020;128:1–6.

    Article  PubMed  Google Scholar 

  43. Hashimoto DA, Rosman G, Rus D, Meireles OR. Artificial intelligence in surgery: promises and perils. Ann Surg. 2018;268:70–6.

    Article  PubMed  Google Scholar 

  44. Hino H, Shiomi A, Hatakeyama K, Kagawa H, Manabe S, Yamaoka Y, et al. Comprehensive genetic characterization of rectal cancer in a large cohort of Japanese patients: differences according to tumor location. J Gastroenterol. 2022. https://doi.org/10.1007/s00535-022-01875-7,April21.

    Article  PubMed  Google Scholar 

  45. Taylor FGM, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol. 2014;32:34–43.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Shunsuke Kasai, Hiroyasu Kagawa, Akio Shiomi, Hitoshi Hino, Shoichi Manabe, Yusuke Yamaoka, Kai Chen, Kenji Nanishi & Chikara Maeda

  2. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Shunsuke Kasai & Yusuke Kinugasa

Authors
  1. Shunsuke Kasai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroyasu Kagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akio Shiomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hitoshi Hino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shoichi Manabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yusuke Yamaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kai Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenji Nanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chikara Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yusuke Kinugasa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyasu Kagawa.

Ethics declarations

Conflict of interest

Yusuke Kinugasa received lecture fees from Johnson and Johnson and Intuitive Surgical.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kasai, S., Kagawa, H., Shiomi, A. et al. Long-term outcomes of upfront robotic rectal cancer surgery: a single-center, retrospective cohort study in Japan. Surg Today 53, 1028–1037 (2023). https://doi.org/10.1007/s00595-023-02648-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-023-02648-2

Keywords

Search

Navigation