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Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery

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Abstract

Background

This study evaluated the feasibility of robot-assisted intersphincteric resection (ISR) for low rectal cancer. Further, we attempted to analyze the learning curve for robotic surgery.

Methods

A total of 64 patients were retrospectively chart-reviewed. Patients were classified into a laparoscopic procedure (n = 28) group and a robot-assisted (n = 36) group. Comparisons of age, gender, clinical staging, operating time, complications, and pathologic status were analyzed. Besides, we used a seventh-order moving average method for the construction of a learning curve in robotic surgery.

Results

Operating time was 374.3 min (range, 210–570 min) in the laparoscopic group and 485.8 min (range, 315–720 min) in the robotic group, with statistical difference between these two groups (P < 0.001). Thirteen patients (46.4 %) received diverting stoma in the laparoscopic group and seven patients (19.4 %) in the robotic group, with statistical difference between these two groups (P = 0.021). Operative experience of robotic ISR showed that the mean operating time was 519.5 min (range, 360–720 min) in the first stage and 448.2 min (range, 315–585 min) in the second stage, with statistical difference between these two stages (P = 0.02). Multifactorial analysis showed that protective diverting stoma creation or neorectum necrosis was not associated with age, sex, pretreatment T stage, or surgeons’ experience.

Conclusions

Our data shows that robot-assisted ISR for low rectal cancer is feasible and safe with no compromising oncological outcomes. The surgeons’ experience improves operating time in robotic surgery.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan

    Li-Jen Kuo

  2. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Li-Jen Kuo & Yu-Jia Chang

  3. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Li-Jen Kuo & Yu-Jia Chang

  4. Biostatistics and Research Consultation Center, Taipei Medical University, Taipei, Taiwan

    Yen-Kuang Lin

  5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    Chun-Chao Chang

  6. Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    Cheng-Jeng Tai

  7. Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan

    Jeng-Fong Chiou

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  1. Li-Jen Kuo
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Correspondence to Li-Jen Kuo.

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Kuo, LJ., Lin, YK., Chang, CC. et al. Clinical outcomes of robot-assisted intersphincteric resection for low rectal cancer: comparison with conventional laparoscopy and multifactorial analysis of the learning curve for robotic surgery. Int J Colorectal Dis 29, 555–562 (2014). https://doi.org/10.1007/s00384-014-1841-y

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