Robotic Rectal Cancer Resection: A Retrospective Multicenter Analysis
Conventional laparoscopy has been applied to colorectal resections for more than 2 decades. However, laparoscopic rectal resection is technically demanding, especially when performing a tumor-specific mesorectal excision in a difficult pelvis. Robotic surgery is uniquely designed to overcome most of these technical limitations. The aim of this study was to confirm the feasibility of robotic rectal cancer surgery in a large multicenter study.
Retrospective data of 425 patients who underwent robotic tumor-specific mesorectal excision for rectal lesions at seven institutions were collected. Outcome data were analyzed for the overall cohort and were stratified according to obese versus non-obese and low versus ultra-low resection patients.
Mean age was 60.9 years, and 57.9 % of patients were male. Overall, 51.3 % of patients underwent neoadjuvant therapy, while operative time was 240 min, mean blood loss 119 ml, and intraoperative complication rate 4.5 %. Mean number of lymph nodes was 17.4, with a positive circumferential margin rate of 0.9 %. Conversion rate to open was 5.9 %, anastomotic leak rate was 8.7 %, with a mean length of stay of 5.7 days. Operative times were significantly longer and re-admission rate higher for the obese population, with all other parameters comparable. Ultra-low resections also had longer operative times.
Robotic-assisted minimally invasive surgery for the treatment of rectal cancer is safe and can be performed according to current oncologic principles. BMI seems to play a minor role in influencing outcomes. Thus, robotics might be an excellent treatment option for the challenging patient undergoing resection for rectal cancer.
KeywordsRectal Cancer Total Mesorectal Excision Circumferential Resection Margin Conventional Laparoscopy Laparoscopic Rectal Resection
The authors acknowledge the following personnel from Intuitive Surgical, Inc. for their support during manuscript preparation and review: Usha Kreaden, MS, Principal Biostatistician for statistical analysis, and Shilpa Mehendale, MS, MBA, Director of Clinical Affairs. This study was sponsored and funded by Intuitive Surgical, Inc. in collaboration with the study investigators under a cooperative clinical study agreement. The authors had full control of the study execution, analysis, and development of the manuscript.
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