Abstract
From January 2011 to December 2015, 70 consecutive patients underwent either laparoscopic surgery (LS) or robotic surgery (RS) total mesorectal excision (TME) for malignancy. Data were prospectically recorded in a dedicated local database including ASA score, age, operative time, conversion rate, re-operation rate, early complications, length of stay, and pathological results. We enrolled 70 consecutive patients, 35 treated with LS (18 M, 17 F), 35 treated with RS (23 M, 12 F). Median total operative time was 225 min in LS group (IQR 194–255) and 252.5 min for RS group (IQR 214–300). Median first flatus time was 2 days for LS group (IQR 1–3) and 1 day for RS group (IQR 1–2). Stool discharge time (median) was 4 days for LS group (IQR 2–5) and 2 days for RS group (IQR 1–3). Length of stay (median) was 8 days in LS group (IQR 7–10) and 7 days in RS group (IQR 5–8). It was not found any statistically significant difference between the two groups when we analyzed the number nodes harvested the postoperative complications. The 30 day mortality was 0% in both two groups. The conversion rate for LS group was 23% (8/35 pts) and that for RS group was 0% (0/35). The RS may overcome technical limitations of LS. In our experience, it is a feasible and safe technique, it achieves better clinical outcomes due to the lower conversion rate compared to LS, although with higher costs.
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Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Tele-robotic assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694
Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith Adrian MH, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25:3061–3068
Poulin EC, Mamazza J, Schlachta CM, Gregoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 229(4):487–492
Hasegawa H, Kabeshima Y, Watanabe M, Yamamoto S, Kitajima M (2003) Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer. Surg Endosc 17:636–640. https://doi.org/10.1007/s00464-002-8516-4
Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14(6):329–334
Champault GG, Barrat C, Raselli R, Elizalde A, Catheline J-M (2002) Laparoscopic versus open surgery for colorectal carcinoma. Surg Laparosc Endosc Percutan Tech 12(2):88–95
Delgado S, Lacy AM, Filella X, Castells A, García-Valdecasas JC, Pique JM, Momblán D, Visa J (2001) Acute phase response in laparoscopic and open colectomy in colon cancer. Randomized study. Dis Colon Rectum 44(5):638–646
Jian-Kun H, Zhou Z-G, Chen Z-X, Wang L-L, Yong-Yang Yu, Liu J, Zhang B, Li L, Shu Y, Chen J-P (2003) Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rectal cancer. World J Gastroenterol 9(12):2690–2694
Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328
Nelson H, Sargent D, Wieand HS, The Clinical Outcomes of Surgical Therapy Study Group et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Cadiere GB, Himpens J, Germay O et al (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25:1467–1477
Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22(7):1601–1608. https://doi.org/10.1007/s00464-008-9752-z (Epub 2008 Feb 13)
Ballantyne GH (2002) Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc. 16(10):1389–1402 (Epub 2002 Jul 29)
D’Annibale A, Pernazza G, Pende V, Monsellato I (2010) Minimally invasive robot—assisted ColoTMEs robot surgery, Book edited by: Seung Hyuk Baik, January 2010, INTECH
Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784
Van der Pas MH, Deijen CL, Abis GS, de Lange-de Klerk ES, Haglind E, Fürst A, Lacy AM, Cuesta MA, Bonjer HJ, COLOR II study group (2016) Conversions in laparoscopic surgery for rectal cancer. Surg Endosc 31:2263–2270
Allaix ME, Furnée EJ, Mistrangelo M, Arezzo A, Morino M (2016) Conversion of laparoscopic coloTME for cancer: what is the impact on short-term outcomes and survival? World J Gastroenterol 22(37):8304–8313
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(2):205–213
Woeste G, Bechstein WO, Wullstein C (2005) Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis 20:253–257
Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46(12):1633–1639
Rockall TA, Darzi A (2003) Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am 83:1463–1468
Kim YS, Kim MJ, Park SC, Sohn DK, Kim DY, Chang HJ, Nam BH, Oh JH (2016) Robotic versus laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy: case-matched study of short-term outcomes. Cancer Res Treat. 48(1):225–231
Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261(1):129–137
Yoo BE, Cho JS, Shin JW, Lee DW, Kwak JM, Kim J, Kim SH (2015) Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol 22(4):1219–1225
Gorgun E, Ozben V, Costedio M, Stocchi L, Kalady M, Remzi F (2016) Robotic versus conventional laparoscopic rectal cancer surgery in obese patients. Colorectal Dis 18:1063–1071
Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Short and long-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a case-matched retrospective study. Medicine (Baltimore). 94(11):e522
Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J (2015) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19(3):516–526
Pai A, Melich G, Marecik SJ, Park JJ, Prasad LM (2015) Current status of robotic surgery for rectal cancer: a bird’s eye view. J Minim Access Surg 11(1):29–34
Hellan M, Ouellette J, Lagares-Garcia JA, Rauh SM, Kennedy HL, Nicholson JD, Nesbitt D, Johnson CS, Pigazzi A (2015) Robotic rectal cancer resection: a retrospective multicenter analysis. Ann Surg Oncol 22:2151–2158
Sun Y, Xu H, Li Z, Han J, Song W, Wang J, Xu Z (2016) Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol. 14(1):61
Melich G, Hong YK, Kim J, Hur H, Baik SH, Kim NK, Sender Liberman A, Min BS (2015) Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg Endosc 29(3):558–568
Lee SH, Lim S, Kim JH, Lee KY (2015) Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 89(4):190–201
Moghadamyeghaneh Z, Masoomi H, Mills SD, Carmichael JC, Pigazzi A, Nguyen NT, Stamos MJ (2014) Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS 18(4):e2014.00230 10
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
Wang Y, Zhao GH, Yang H, Lin J (2016) A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Technol 26:259–264
Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, Ma Y (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19(12):3727–3736
Jane D, Pigazzi A, Marshall H, Croft J, Corrigan N et al (2017) Effect of robotic assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. JAMA 318(16):1569–1580
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Mégevand, J.L., Lillo, E., Amboldi, M. et al. TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique—cumulative experience in a single centre. Updates Surg 71, 331–338 (2019). https://doi.org/10.1007/s13304-019-00655-y
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DOI: https://doi.org/10.1007/s13304-019-00655-y