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Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes

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Abstract

The aim of our study was to compare long term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neoadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter-saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). Median follow-up 87 months (1–152). Whereas local recurrence was seen in eight cases (10.12%) and distant metastasis was seen in 18 cases (22.7%). Overall, 5 years survival was 83.3% in R-TME, 75% in L-TME groups. R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid to low RC after NCRT.

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References

  1. Daniels IR, Fisher SE, Heald RJ, Moran BJ (2007) Accurate staging, selective preoperative therapy, and optimal surgery improves outcome in rectal cancer: a review of the recent evidence. Colorectal Dis 9:290–301

    Article  CAS  Google Scholar 

  2. Kapiteijn E, Putter H, van de Velde CJ, Cooperative investigators of the Dutch ColoRectal Cancer Group (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 89:1142–1149

    Article  Google Scholar 

  3. Martling A, Holm T, Rutqvist LE et al (2005) Impact of a surgical training program on rectal cancer outcomes in Stockholm. Br J Surg 92:225–229

    Article  CAS  Google Scholar 

  4. Wibe A, Møller B, Norstein J et al (2002) Norwegian rectal cancer group. A national strategic change in treatment policy for rectal cancer–implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 45:857–866

    Article  Google Scholar 

  5. Minsky BD, Cohen AM, Kemeny N et al (1993) The efficacy of preoperative 5-fluorouracil, high-dose leucovorin, and sequential radiation therapy for unresectable rectal cancer. Cancer 71:3486–3492

    Article  CAS  Google Scholar 

  6. Theodoropoulos G, Wise WE, Padmanabhan A et al (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45:895–903

    Article  Google Scholar 

  7. Staudacher C, Vignali A (2010) Laparoscopic surgery for rectal cancer: the state of the art. World J Gastrointest Surg 2:275–282

    Article  Google Scholar 

  8. Poon JT, Law WL (2009) Laparoscopic resection for rectal cancer: a review. Ann Surg Oncol 16:3038–3047

    Article  Google Scholar 

  9. Guillou PJ, Quirke P, Thorpe P et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726

    Article  Google Scholar 

  10. Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the medical research council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82

    Article  CAS  Google Scholar 

  11. van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  Google Scholar 

  12. Caudle AS, Hunt KK, Tucker SL et al (2012) American College of surgeons oncology group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol 19(10):3144–3151. https://doi.org/10.1245/s10434-012-2531-z

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the alacart randomized clinical trial. JAMA 314(13):1356–1363

    Article  CAS  Google Scholar 

  14. Baik SH, Kwon HY, Kim JS et al (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487

    Article  Google Scholar 

  15. Bianchi PP, Ceriani C, Locatelli A et al (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24:2888–2889

    Article  CAS  Google Scholar 

  16. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case matched analysis of short-term outcomes. Ann Surg Oncol 17:3195–3202

    Article  Google Scholar 

  17. Saklani AP, Lim DR, Hur H et al (2013) Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Colorectal Dis 28:1689–1698

    Article  Google Scholar 

  18. Serin KR, Gultekin FA, Batman B, Ay S, Kapran Y, Saglam S, Asoglu O (2015) Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison short-term outcomes. J Robotic Surg 9(3):187–194

    Article  Google Scholar 

  19. Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243

    Article  CAS  Google Scholar 

  20. Balik E, Asoglu O, Saglam S et al (2010) Effects of surgical laparoscopic experience on the short-term postoperative outcome of rectal cancer: results of a high volume single center institution. Surg Laparosc Endosc Percutan Tech 20:93–99

    Article  Google Scholar 

  21. Asoglu O, Kunduz E, Rahmi Serin K et al (2014) Standardized laparoscopic sphincter preserving total mesorectal excision for rectal cancer: long-term oncologic outcome in 217 unselected consecutive patients. Surg Laparosc Endosc Percutan Tech 24:145–152

    Article  Google Scholar 

  22. Asoglu O, Balik E, Kunduz E et al (2013) Laparoscopic surgery for rectal cancer: outcomes in 513 patients. World J Surg 37:883–892

    Article  Google Scholar 

  23. Clancy C, O’Leary DP, Burke JP, Redmond HP, Coffey JC, Kerin MJ, Myers E (2015) A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis 17(6):482–490

    Article  CAS  Google Scholar 

  24. Corrigan Neil, Marshall Helen, Croft Julie, Copeland Joanne, Jayne David, Brown Julia (2018) Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection. Trials 19:33

    Article  Google Scholar 

  25. Bademler S, Koza KB, Ucuncu MZ, Tokmak H, Bakir B, Oral EN, Asoglu O (2019) Standardized laparoscopic sphincter-preserving total mesorectal excision for rectal cancer: median of 10 years long-term oncologic outcome in 217 unselected consecutive patients. Surg Laparosc Endosc Percutan Tech. https://doi.org/10.1097/sle.0000000000000664

    Article  PubMed  Google Scholar 

  26. 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):1279–1286

    Article  Google Scholar 

  27. Jayne D, Pigazzi A, Marshall H et al (2017) 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 318(16):1569–1580

    Article  Google Scholar 

  28. Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL (2019) Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials. Asian J Surg 42(6):657–666

    Article  Google Scholar 

  29. Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C, De Forges H, Emmanuel Colombo PE (2018) Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol 25(12):3572–3579

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to Ucuncu Zubeyir Muhammad MD (Derindere Hospital; Istanbul, Turkey) for contribution to the statistical analysis, to Hammad Muhammad Ahmed MD, PhD (Mansoure Univeristy; Egypt) for reviewing the article and Abdulla Huseyn PhD researcher (Texas A&M University, USA) for the grammar checking.

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Authors and Affiliations

  1. Bosphorus Clinical Research Academy, Vişnezade Mah., Acısus Sokak, Salihbey Apt. No:16/D:5. Beşiktaş, Istanbul, Turkey

    Oktar Asoglu & Vusal Aliyev

  2. Department of Nuclear Medicine, Acıbadem University Macka Hospital, Istanbul, Turkey

    Handan Tokmak

  3. Department of Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey

    Baris Bakir

  4. Department of General Surgery, Florence Nightingale Hospital, Istanbul, Turkey

    Vusal Aliyev

  5. Department of Medical Oncology, Florence Nightingale Hospital, Istanbul, Turkey

    Sezer Saglam

  6. Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, Turkey

    Yalın Iscan & Suleyman Bademler

  7. Department of General Surgery, Health Sciences University Bagcılar Training and Research Hospital, Istanbul, Turkey

    Serhat Meric

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  1. Oktar Asoglu
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  4. Vusal Aliyev
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Correspondence to Oktar Asoglu.

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Conflict of interest

Author Oktar Asoglu, Author Handan Tokmak, Author Baris Bakir, Author Vusal Aliyev, Author Sezer Saglam, Author Yalın Iscan, Author Suleyman Bademler, and Author Serhat Meric declare that they have no conflicts of interest or financial ties to disclose.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Asoglu, O., Tokmak, H., Bakir, B. et al. Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes. J Robotic Surg 14, 393–399 (2020). https://doi.org/10.1007/s11701-019-01001-5

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