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Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

In recent years, colorectal cancer surgery has benefitted from new techniques such as laparoscopy and robotic surgery. However, many treatment disparities exist among different centers for patients affected by the same kind of tumors.

Methods

Forty-five (41%) open (OCO) vs. 30 (28%) laparoscopic (LCO) vs. 34 (31%) robotic-assisted (RCO) colectomies and 34 (40%) open (ORR) vs. 52 (60%) robotic (ROR) rectal resections performed during a 15-month period, in elective setting, were compared. Patients presenting contraindications for minimally invasive procedures were excluded from the study, so that all the enrolled patients were suitable for either of the surgical procedures.

Results

Overall morbidity rates were similar among groups. Perioperative mortality was nil. No significant differences were noted as for total number of lymph nodes harvested between arms. Mean time (days) to first bowel movement to gas was 3.3 vs. 2.3 vs. 2.6 for OCO, LCO, and RCO, respectively (p < 0.001), and 3.3 vs. 2.0 for ORR and ROR, respectively (p = 0.003). Among several European Organization in Research and Treatment of Cancer QLQ-C30 functional scales considered only physical functioning was significantly better at 30 days for RCO vs. OCO (96.3 ± 10 RCO vs. 85.5 ± 12.6 OCO; p = 0.015). Robotic surgery was much more expensive in comparison to open as well as laparoscopic procedures.

Conclusions

Laparoscopic and robotic surgeries for colorectal cancer present both the same advantages in comparison to open procedures in terms of faster recovery. However, our data do not seem to support the routine use of RCO as a cost-effective procedure.

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Abbreviations

FTS:

Fast-track surgery

QoL:

Quality of life

CRM:

Circumferential resection margin

CT:

Computed tomography

TME:

Total mesorectal excision

MBP:

Mechanical bowel preparation

IMV:

Inferior mesenteric vein

IMA:

Inferior mesenteric artery

SSI:

Surgical site infection

ERAS:

Enhanced recovery after surgery

EORTC:

European Organization in Research and Treatment of Cancer

OCO:

Open colectomies

LCO:

Laparoscopic colectomies

RCO:

Robotic colectomies

ORR:

Open rectal resections

ROR:

Robotic rectal resection

BMI:

Body mass index

LTME:

Laparoscopic TME

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Acknowledgments

The authors thank William Russell-Edu for help with English and Liliana Tadini, Marina Mancini (research nurses), Laura Ogliari, Marisa Lamberti, (scrub nurses), Alfonso Lorusso (administrative staff) for their contribution to this study.

Conflict of interest

All the Authors declare no potential conflict of interests connected with this paper.

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Authors and Affiliations

  1. Division of General and Laparoscopic Surgery, European Institute of Oncology, Via G. Ripamonti, 435, 20141, Milan, Italy

    Emilio Bertani, Antonio Chiappa, Paolo Pietro Bianchi, Vittorio Branchi, Irene Vetrano & Bruno Andreoni

  2. Division of Abdomino Pelvic Surgery, European Institute of Oncology, Milan, Italy

    Roberto Biffi & Sabine Cenciarelli

  3. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Davide Radice

  4. Planning and Control, European Institute of Oncology, Milan, Italy

    Elena Cenderelli

Authors
  1. Emilio Bertani
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  2. Antonio Chiappa
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  3. Roberto Biffi
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Correspondence to Emilio Bertani.

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Bertani, E., Chiappa, A., Biffi, R. et al. Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches. Int J Colorectal Dis 26, 1317–1327 (2011). https://doi.org/10.1007/s00384-011-1270-0

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