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Perioperative and long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision: a retrospective study of 672 patients

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Abstract

Although there’s growing information about the long-term oncological effects of robotic surgery for rectal cancer, the procedure is still relatively new. This study aimed to assess the long-term oncological results of total mesorectal excision (TME) performed laparoscopically versus robotically in the setting of rectal cancer. Restrospective analysis of a prospectively maintained database. A total of 489 laparoscopic (L-TME) and 183 robotic total mesorectal excisions (R-TME) were carried out by a single surgeon between 2013 and 2023. The groups were compared in terms of perioperative and long-term oncological outcomes. In the R-TME and L-TME groups, male sex predominated (75.4% and 57.3%, respectively), although the robotic group was significantly greater (p = 0.008). There was no conversion in R-TME group, whereas three (0.6%) converted to open surgery in L-TME group. The R-TME group had a statistically significant higher number of distal rectal tumors (85%) compared to the L-TME group (54.6%). Only three (1.7%) patients in the R-TME group received abdomineperineal resection (APR); in contrast, 25 (5%) patients in the L-TME group received APR (p < 0.001). For R-TME, the mean follow-up was 70.7 months (range 18–138) and for L-TME, it was 60 months (range 14–140). Frequency of completed mesorectum was significantly greater in R-TME group (98.9% vs 94.2%, p < 0.001). The 5 year overall survival rates for R-TME and L-TME groups were 89.6% and 88.7%, respectively. The 5 year disease-free survival for R-TME and L-TME groups were 84.1% and 81.1%, respectively. The local recurrences rates were 7.6% and 6.3%, respectively in R-TME and L-TME groups (p = 0.274). R-TME is characterized by no conversion and improved mesorectal integrity. R-TME had longer operation time. The long-term oncological outcomes were comparable between groups.

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Data availability

The datasets used or analysed during the current study are available from the corresponding author upon reasonable request.

References

  1. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    Article  CAS  PubMed  Google Scholar 

  2. Guillou PJ, Quirke P, Thorpe H et al (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

    Article  PubMed  Google Scholar 

  3. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645

    Article  PubMed  Google Scholar 

  4. Huang M-J, Liang J-L, Wang H et al (2011) Laparoscopic assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis 26:415–421

    Article  PubMed  Google Scholar 

  5. Ng SSM, Lee JFY, Yiu RYC et al (2014) Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials. Ann Surg 259:139–147

    Article  PubMed  Google Scholar 

  6. Park EJ, Cho MS, Baek SJ et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137

    Article  PubMed  Google Scholar 

  7. Corcione F, Esposito C, Cuccurullo D et al (2005) Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 19:117–119

    Article  CAS  PubMed  Google Scholar 

  8. Bademler S, Koza KB, Ucuncu MZ, Tokmak H, Bakir B, Oral EN et al (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 29:354–361

    Article  PubMed  Google Scholar 

  9. Aliyev V, Tokmak H, Goksel S, Guven K, Bakir B, Kay H et al (2020) Robotic sphincter-saving total mesorectal excision for rectal cancer treatment: a single-surgeon experience in 103 consecutive male patients. Surg Technol Int 37:93–98

    PubMed  Google Scholar 

  10. Aliyev V, Tokmak H, Goksel S, Meric S, Acar S, Kaya H et al (2020) The long-term oncological outcomes of the 140 robotic sphincter-saving total mesorectal excision for rectal cancer: a single surgeon experience. J Robot Surg 14:655–661

    Article  PubMed  Google Scholar 

  11. Weiser MR (2018) AJCC 8th edition: colorectal cancer. Ann Surg Oncol 25:1454–1455

    Article  PubMed  Google Scholar 

  12. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J et al (2009) Efect 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 373:821–828

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH, Pathology Review C et al (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the international study group of rectal cancer. Surgery 147:339–351

    Article  PubMed  Google Scholar 

  16. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349

    Article  Google Scholar 

  17. 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. https://doi.org/10.1016/S1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  18. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA et al (2019) 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 269(4):589–595. https://doi.org/10.1097/SLA.0000000000003002

    Article  PubMed  Google Scholar 

  19. Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Efect 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  PubMed  Google Scholar 

  20. 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  PubMed  Google Scholar 

  21. Aliyev V, Arslan NC, Goksoy B, Guven K, Goksel S, Asoglu O (2022) Is robotic da vinci xi® superior to the da vinci si® for sphincter-preserving total mesorectal excision? Outcomes in 150 mid-low rectal cancer patients. J Robot Surg 16(6):1339–1346

    Article  PubMed  Google Scholar 

  22. 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 

  23. Neil C, Helen M, Julie C et al (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. https://doi.org/10.1186/s13063-018-2726-0

    Article  Google Scholar 

  24. 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  PubMed  Google Scholar 

  25. Asoglu O, Tokmak H, Bakir B, Aliyev V, Saglam S, Iscan Y, Bademler S, Meric S (2020) 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 Robot Surg 14(3):393–399

    Article  PubMed  Google Scholar 

  26. Aliyev V, Goksel S, Bakir B, Guven K, Asoglu O (2021) Sphincter-saving robotic total mesorectal excision provides better mesorectal specimen and good oncological local control compared with laparoscopic total mesorectal excision in male patients with mid-low rectal cancer. Surg Technol Int 20(38):160–166. https://doi.org/10.52198/21.STI.38.CR1391. (PMID: 33537982)

    Article  Google Scholar 

  27. Aliyev V, Piozzi GN, Bulut A, Guven K, Bakir B, Saglam S, Goksel S, Asoglu O (2022) Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting a median of 7 year long-term oncological and functional outcomes. Updates Surg. https://doi.org/10.1007/s13304-022-01396-1

    Article  PubMed  Google Scholar 

  28. Aliyev V, Piozzi GN, Huseynov E, Mustafayev TZ, Kayku V, Goksel S, Asoglu O (2023) Robotic male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal cancer share similar specimen quality, complication rates and long-term oncological outcomes. J Robot Surg 17(4):1637–1644. https://doi.org/10.1007/s11701-023-01558-2. (Epub 2023 Mar 21 PMID: 36943657)

    Article  PubMed  Google Scholar 

  29. Aliyev V, Piozzi GN, Shadmanov N, Guven K, Bakır B, Goksel S, Asoglu O (2023) Robotic and laparoscopic sphincter-saving resections have similar peri-operative, oncological and functional outcomes in female patients with rectal cancer. Updates Surg 75(8):2201–2209. https://doi.org/10.1007/s13304-023-01686-2. (Epub 2023 Nov 13 PMID: 37955804)

    Article  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Bogazici Academy for Clinical Sciences, Istanbul, Turkey

    Niyaz Shadmanov, Vusal Aliyev & Oktar Asoglu

  2. Department of General Surgery, Bagcılar Medilife Hospital, Istanbul, Turkey

    Vusal Aliyev

  3. Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK

    Guglielmo Niccolò Piozzi

  4. Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Barıs Bakır

  5. Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey

    Suha Goksel

Authors
  1. Niyaz Shadmanov
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  2. Vusal Aliyev
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  3. Guglielmo Niccolò Piozzi
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  4. Barıs Bakır
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  5. Suha Goksel
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  6. Oktar Asoglu
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Contributions

Conceptualization: Oktar Asoglu, Niyaz Shadmanov, Vusal Aliyev; methodology: Oktar Asoglu; Niyaz Shadmanov; formal analysis and investigation: Niyaz Shadmanov, Oktar Asoglu; writing—original draft preparation: Niyaz Shadmanov, Vusal Aliyev, Oktar Asoglu; writing—review and editing: Niyaz Shadmanov, Vusal Aliyev, Guglielmo Niccolò Piozzi, Barıs Bakır, Suha Goksel, Oktar Asoglu; supervision: Oktar Asogl.

Corresponding author

Correspondence to Oktar Asoglu.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was conducted in compliance with the Principles of the Declaration of Helsinki. Institutional Review Board (IRB) approval was waived following the retrospective nature of the study.

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Informed consent was obtained from all individual participants included in the study.

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Shadmanov, N., Aliyev, V., Piozzi, G.N. et al. Perioperative and long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision: a retrospective study of 672 patients. J Robotic Surg 18, 144 (2024). https://doi.org/10.1007/s11701-024-01922-w

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