Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center

Ramji, Karim; Cleghorn, Michelle C.; Josse, Jonathan M.; MacNeill, Andrea; O’Brien, Catherine; Urbach, David R.; Quereshy, Fayez A.

doi:10.1007/s00464-015-4390-8

Cited by 72 publications

(94 citation statements)

References 8 publications

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“…[10,11,14–17,19,23,25,26,29] Three studies [14,16,25] showed that EBL was lower for RTME than LTME, although no significant difference was found in the rest of studies. Pooled data analysis revealed that there was no significant difference in EBL between the techniques [WMD = −12.45, 95% CI (−48.66 to 23.76), P = .500], with a high heterogeneity (I 2 = 75.9%; P < .001) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies [10–14,16,19,24–26,28,29] showed rate of conversion to open procedure. Overall, no significant difference was found between techniques, except in 1 study.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, no significant difference was found between techniques, except in 1 study. [16] Pooled data analysis demonstrated that the rate of conversion to open procedure was lower in RTME than LTME [OR = 0.35, 95% CI (0.19–0.62); P < .001; I 2 = 0.0%] (Fig. 4).…”

Section: Resultsmentioning

confidence: 99%

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The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

Wang²,

Liang³

et al. 2017

Medicine

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Background:The aim of this study was to assess the safety and effectiveness of robotic-assisted versus laparoscopic total mesorectal excision (TME) in patients with rectal cancer.Methods:We systematically searched PubMed, EMBASE, Cochrane library, Web of science, and Chinese Biomedical Literature Database up to July 2016 to identify case-controlled studies that compared robotic TME (RTME) with laparoscopic TME (LTME) for rectal cancer. GRADE was used to interpret the primary outcomes of this meta-analysis.Results:We included 17 case–control studies (3601 participants: 1726 underwent RTME and 1875 LTME for rectal cancer) that compared RTME with LTME for rectal cancer. We found no statistically significant differences between techniques for local recurrence [odds ratio (OR) = 0.68, P = .216] and overall survival at 3 years (OR = 0.71, P = 1.140), complications (OR = 1.02, P = .883), positive circumferential resection margin (PCRM) (OR = 0.80, P = .256), the first passing flatus [weighted mean difference (WMD) = −0.11, P = .130], reoperation (OR = 0.66, P = .080), estimated blood loss (EBL) (WMD = −12.45, P = .500), and length of stay in hospital (LOS) (WMD = −0.69, P = .089). Compared with LTME, RTME was associated with lower rate of conversion (OR = 0.35, P < .001), urinary retention (OR = 0.41, P = .025), and longer operative time (WMD = 57.43, P < .001). The overall quality of evidence was poor in all outcomes.Conclusion:RTME in patients with rectal cancer was associated with a lower rate of conversion and less incidence of urinary retention. Generally, operative time in RTME was significantly longer than in LTME. The long-term oncological and function outcomes of RTME seem to be equivalent with LTME. Therefore, analysis of current studies to date did not indicate a major benefit of RTME over LTME.

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Section: Resultsmentioning

confidence: 99%

“…Twelve studies [10–14,16,19,24–26,28,29] showed rate of conversion to open procedure. Overall, no significant difference was found between techniques, except in 1 study.…”

Section: Resultsmentioning

confidence: 99%

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The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

Wang²,

Liang³

et al. 2017

Medicine

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“…It is difficult to assess whether the difference in conversion rate with robotic surgery warrants widespread adoption of this technique given the increased cost. Ramji and colleagues 28 report on a Canadian series comparing robotic, laparoscopic and open rectal cancer resections. They found an incremental cost difference of approximately $6000 per case for robotic resections versus either laparoscopic or open resections.…”

Section: Discussionmentioning

confidence: 99%

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

Feinberg

Elnahas

Bashir

et al. 2016

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Background: Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes. Methods:The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent robotic or laparoscopic colorectal surgery in 2013. We performed a logistic regression analysis to compare intraoperative variables and 30-day outcomes.Results: There were 8392 patients who underwent laparoscopic colorectal surgery and 472 patients who underwent robotic colorectal surgery. The robotic cohort had a lower incidence of unplanned intraoperative conversion (9.5% v. 13.7%, p = 0.008). There were no significant differences between robotic and laparoscopic surgery with respect to other intraoperative and postoperative outcomes, such as operative duration, length of stay, postoperative ileus, anastomotic leak, venous thromboembolism, wound infection, cardiac complications and pulmonary complications. On multivariable analysis, robotic surgery was protective for unplanned conversion, while male sex, malignancy, Crohn disease and diverticular disease were all associated with open conversion. Conclusion:Robotic colorectal surgery has comparable 30-day perioperative morbidity to laparoscopic surgery and may decrease the rate of intraoperative conversion in select patients.Contexte : La chirurgie robotique est de plus en plus utilisée comme option de rechange peu effractive à la laparoscopie classique. La robotique permet de remédier à bon nombre des restrictions techniques et ergonomiques de la chirurgie laparoscopique, mais peu d'articles font état des résultats cliniques en chirurgie colorectale. Nous avons donc cherché à comparer les 2 techniques de résection colorectale en ce qui concerne les résultats peropératoires dans les 30 jours suivant l'intervention.Méthodes : À l'aide de base de données du National Surgical Quality Improvement Program de l'American College of Surgeons, nous avons recensé tous les patients ayant subi une résection colorectale par chirurgie laparoscopique ou robotique en 2013. Nous avons ensuite mené une analyse de régression logistique pour comparer des variables peropératoires et les résultats après 30 jours.Résultats : En tout, 8392 patients avaient subi une chirurgie colorectale par laparoscopie pendant la période visée, et 472 avaient subi une intervention par chirurgie robotique. Le second groupe avait une incidence plus faible de conversion peropéra-toire imprévue (9,5 % par rapport à 13,7 %; p = 0,008). On n'a relevé aucune différence significative entre les 2 types d'intervention quant aux autres résultats peropératoires et postopératoires, soit la durée de l'intervention, la durée du séjour à l'hôpital et la survenue d'un iléus, d'une fui...

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“…Rectal cancer surgery in locally advanced stages is associated with more blood loss; longer operation duration; more concomitant organ resections; and more postoperative complications such as anastomotic leakage, pelvic floor dysfunction, incontinence and genitourinary problems. However, robotic rectal resection may improve perioperative outcomes, such as reduction of perioperative blood loss, and is being explored 177 .…”

Section: Managementmentioning

confidence: 99%

Colorectal cancer

Kuipers

Grady

Lieberman

et al. 2015

Nat Rev Dis Primers

1,312

1,062

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Colorectal cancer had a low incidence several decades ago. However, it has become a predominant cancer and now accounts for approximately 10% of cancer-related mortality in western countries. The ‘rise’ of colorectal cancer in developed countries can be attributed to the increasingly ageing population, unfavourable modern dietary habits and an increase in risk factors such as smoking, low physical exercise and obesity. New treatments for primary and metastatic colorectal cancer have emerged, providing additional options for patients; these treatments include laparoscopic surgery for primary disease, more-aggressive resection of metastatic disease (such as liver and pulmonary metastases), radiotherapy for rectal cancer and neoadjuvant and palliative chemotherapies. However, these new treatment options have had limited impact on cure rates and long-term survival. For these reasons, and the recognition that colorectal cancer is long preceded by a polypoid precursor, screening programmes have gained momentum. This Primer provides an overview of the current state of art knowledge on the epidemiology and mechanisms of colorectal cancer, as well as on diagnosis and treatment.

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Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center

Cited by 72 publications

References 8 publications

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

Colorectal cancer

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