Skip to main content

Advertisement

SpringerLink
Log in

Real-world comparison of curative open, laparoscopic and robotic resections for sigmoid and rectal cancer–single center experience

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

This article has been updated

Abstract

There has been an increase in the utilization of robotic surgery in addition to traditional open or laparoscopic approaches. Aim of this study is to compare the short-term outcomes for open, laparoscopic, and robotic surgery for rectal and sigmoid cancer. One hundred and forty-seven patients (open n = 48, laparoscopic n = 49, robotic n = 50) undergoing curative resections by two surgeons between 2013 and 2020 were included. Data analyzed included patient demographics, tumor characteristics, length of stay, post-operative outcomes, and pathologic surrogates of oncologic results, including total mesorectal excision (TME) quality, circumferential resection margin (CRM) involvement and lymph node (LN) yield. Median age of population was 68 years (IQR 59–73), majority (68%) were males. Median distance from anal verge in the robotic surgery group was 8 cm, compared to 15 and 14.5 cm in the open and laparoscopic groups, respectively, p = 0.029, (laparoscopic vs robotic, p = 0.005 and open vs robotic, p = 0.027). Proportion of patients who received neoadjuvant radiotherapy in robotic surgery group was higher, p = 0.04. In sub-group of tumors between 3 and 7 cm from anal verge more patients in the robotic surgery group had sphincter preservation, p = 0.006. Length of stay, maximum C-reactive protein, and white blood cell rise favored minimally invasive approaches compared to open surgery. There were no differences in post-operative complications, lymph node yield or CRM positivity rate between the three groups. Robotic surgery approach is safe and allows sphincter preservation without compromising TME quality in 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

Similar content being viewed by others

Change history

  • 15 May 2022

    Corresponding author’s e-mail address has been removed.

References

  1. National Bowel Cancer Audit Annual Report 2019 (2019) National Bowel Cancer Audit. Healthcare Quality Improvement Partnership

  2. Duran C, Rodriguez LE, Ramchandani M, Bismuth J (2013) Robotic Surgery: Applications and Advances. Future Medicine, London, United Kingdom

  3. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: The ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, Investigators 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. https://doi.org/10.1001/jama.2015.12009

    Article  CAS  PubMed  Google Scholar 

  5. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, group MCt, (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726. https://doi.org/10.1016/S0140-6736(05)66545-2

    Article  PubMed  Google Scholar 

  6. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, Group CIS (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332. https://doi.org/10.1056/NEJMoa1414882

    Article  CAS  PubMed  Google Scholar 

  7. Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32(4):1636–1655. https://doi.org/10.1007/s00464-018-6079-2

    Article  PubMed  Google Scholar 

  8. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A, Jimenez-Rodriguez RM, Gurrado A, Strippoli GFM (2018) Robotic versus laparoscopic minimally invasive surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Ann Surg 267(6):1034–1046. https://doi.org/10.1097/SLA.0000000000002523

    Article  PubMed  Google Scholar 

  9. Wilkie B, Summers Z, Hiscock R, Wickramasinghe N, Warrier S, Smart P (2019) Robotic colorectal surgery in Australia: a cohort study examining clinical outcomes and cost. Aust Health Rev 43(5):526–530. https://doi.org/10.1071/AH18093

    Article  PubMed  Google Scholar 

  10. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (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. https://doi.org/10.1001/jama.2017.7219

    Article  PubMed  PubMed Central  Google Scholar 

  11. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2011) S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25(1):240–248. https://doi.org/10.1007/s00464-010-1166-z

    Article  PubMed  Google Scholar 

  12. Hollis RH, Cannon JA, Singletary BA, Korb ML, Hawn MT, Heslin MJ (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(11):850–856. https://doi.org/10.1089/lap.2015.0620

    Article  PubMed  Google Scholar 

  13. Taylor JP, Stem M, Althumairi AA, Gearhart SL, Safar B, Fang SH, Efron JE (2020) Minimally invasive proctectomy for rectal cancer: a national perspective on short-term outcomes and morbidity. World J Surg 44(9):3130–3140. https://doi.org/10.1007/s00268-020-05560-9

    Article  PubMed  Google Scholar 

  14. Lee GC, Bordeianou LG, Francone TD, Blaszkowsky LS, Goldstone RN, Ricciardi R, Kunitake H, Qadan M (2020) Superior pathologic and clinical outcomes after minimally invasive rectal cancer resection, compared to open resection. Surg Endosc 34(8):3435–3448. https://doi.org/10.1007/s00464-019-07120-2

    Article  PubMed  Google Scholar 

  15. Chapman BC, Edgcomb M, Gleisner A, Vogel JD (2020) Outcomes in rectal cancer patients undergoing laparoscopic or robotic low anterior resection compared to open: a propensity-matched analysis of the NCDB (2010–2015). Surg Endosc 34(11):4754–4771. https://doi.org/10.1007/s00464-019-07252-5

    Article  PubMed  Google Scholar 

  16. Moghadamyeghaneh Z, Phelan M, Smith BR, Stamos MJ (2015) Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer. Dis Colon Rectum 58(12):1123–1129. https://doi.org/10.1097/DCR.0000000000000475

    Article  PubMed  Google Scholar 

  17. Straatman J, Cuesta MA, Tuynman JB, Veenhof A, Bemelman WA, van der Peet DL (2018) C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial. Surg Endosc 32(6):2877–2885. https://doi.org/10.1007/s00464-017-5996-9

    Article  PubMed  Google Scholar 

  18. Pedersen T, Roikjaer O, Jess P (2012) Increased levels of C-reactive protein and leukocyte count are poor predictors of anastomotic leakage following laparoscopic colorectal resection. Dan Med J 59(12):A4552

    PubMed  Google Scholar 

  19. Quirke P, Dixon MF (1988) The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 3(2):127–131. https://doi.org/10.1007/BF01645318

    Article  CAS  PubMed  Google Scholar 

  20. 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):1521–1525. https://doi.org/10.1007/s00464-005-0855-5

    Article  CAS  PubMed  Google Scholar 

  21. Advice Statement: Robot-assisted surgery compared with laparoscopic resection for the treatment of rectal cancer (2018) Scottish Health Technologies Group

  22. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, Investigators MCN-CCT, Group NCCS (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828. https://doi.org/10.1016/S0140-6736(09)60485-2

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, Cooperative Clinical Investigators of the Dutch Colorectal Cancer G (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20(7):1729–1734. https://doi.org/10.1200/JCO.2002.07.010

    Article  PubMed  Google Scholar 

  24. 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):1480–1487. https://doi.org/10.1245/s10434-009-0435-3

    Article  PubMed  Google Scholar 

  25. Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J (2015) Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg 262(6):1040–1045. https://doi.org/10.1097/SLA.0000000000001017

    Article  PubMed  Google Scholar 

  26. Lykke J, Jess P, Roikjaer O, G Danish Colorectal Cancer (2015) Increased lymph node yield is associated with improved survival in rectal cancer irrespective of neoadjuvant treatment: results from a national cohort study. Dis Colon Rectum 58(9):823–830. https://doi.org/10.1097/DCR.0000000000000429

    Article  PubMed  Google Scholar 

  27. McDonald JR, Renehan AG, O’Dwyer ST, Haboubi NY (2012) Lymph node harvest in colon and rectal cancer: Current considerations. World J Gastrointest Surg 4(1):9–19. https://doi.org/10.4240/wjgs.v4.i1.9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgery, Level 3, Royal Blackburn Hospital, East Lancashire University Hospitals NHS Trust, Blackburn, BB2 3HH, UK

    Saif Akhter Ansari, Muhammad Ahsan Javed, Fatemeh Hedayat, Colin Harris, Michael Gill & Adnan Sheikh

  2. University of Central Lancashire, Preston, UK

    Saif Akhter Ansari & Fatemeh Hedayat

  3. University of Liverpool, Liverpool, UK

    Muhammad Ahsan Javed

Authors
  1. Saif Akhter Ansari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad Ahsan Javed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fatemeh Hedayat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colin Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adnan Sheikh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Saif Akhter Ansari, Fatemeh Hedayat and Muhammad Ahsan Javed. The first draft of the manuscript was written by Muhammad Ahsan Javed and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest and nothing to disclose.

Human and animal rights

This article does not contain any studies with human or animal subjects.

Consent

Consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ansari, S.A., Javed, M.A., Hedayat, F. et al. Real-world comparison of curative open, laparoscopic and robotic resections for sigmoid and rectal cancer–single center experience. J Robotic Surg 16, 315–321 (2022). https://doi.org/10.1007/s11701-021-01239-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-021-01239-y

Keywords

Search

Navigation