Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer

Jayne, David; Pigazzi, Alessio; Marshall, Helen; Croft, Julie; Corrigan, Neil; Copeland, Joanne; Quirke, Philip; West, Nicholas P.; Rautio, Tero; Thomassen, Niels; Tilney, H. S.; Gudgeon, Mark; Bianchi, Paolo Pietro; Edlin, Richard; Hulme, Claire; Brown, Julia

doi:10.1001/jama.2017.7219

Cited by 1,033 publications

(1,042 citation statements)

References 31 publications

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“…By further restricting the available space in the already narrow pelvis, robotic platforms seem ideally suited for this group of patients. This is supported by the initial results of the ROLARR trial (NCT01196000), a large randomised control trial comparing robotic to laparoscopic rectal surgery [34, 35]. Data from this trial was presented at the ASCRS and EAES conferences in June 2015, where conversion rates were lower in the robotic cohort in obese patients [36].…”

Section: Discussionmentioning

confidence: 90%

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Panteleimonitis

Pickering

Abbas

et al. 2018

Int J Colorectal Dis

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PurposeLaparoscopic rectal surgery in obese patients is technically challenging. The technological advantages of robotic instruments can help overcome some of those challenges, but whether this translates to superior short-term outcomes is largely unknown. The aim of this study is to compare the short-term surgical outcomes of obese (BMI ≥ 30) robotic and laparoscopic rectal cancer surgery patients.MethodsAll consecutive obese patients receiving laparoscopic and robotic rectal cancer resection surgery from three centres, two from the UK and one from Portugal, between 2006 and 2017 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for ASA grade, neoadjuvant radiotherapy and pathological T stage. Their short-term outcomes were examined.ResultsA total of 222 patients were identified (63 robotic, 159 laparoscopic). The 63 patients who received robotic surgery were matched with 61 laparoscopic patients. Cohort characteristics were similar between the two groups. In the robotic group, operative time was longer (260 vs 215 min; p = 0.000), but length of stay was shorter (6 vs 8 days; p = 0.014), and thirty-day readmission rate was lower (6.3% vs 19.7%; p = 0.033).ConclusionsIn this study population, robotic rectal surgery in obese patients resulted in a shorter length of stay and lower 30-day readmission rate but longer operative time when compared to laparoscopic surgery. Robotic rectal surgery in the obese may be associated with a quicker post-operative recovery and reduced morbidity profile. Larger-scale multi-centre prospective observational studies are required to validate these results.

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Section: Discussionmentioning

confidence: 90%

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Panteleimonitis

Pickering

Abbas

et al. 2018

Int J Colorectal Dis

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“…This international multicenter prospective RCT randomized 471 patients from 29 centers in 10 countries to robotic versus laparoscopic resections for rectal cancer 66. The primary outcome was the conversion rate, and the secondary outcomes included 30 day morbidity and mortality, CRM positivity, three year local recurrence rate, disease-free and overall survival rates, and sexual and urinary complications.…”

Section: Types Of Robotic Modelsmentioning

confidence: 99%

The role of robotics in colorectal surgery

Cheng

Rezac

2018

BMJ

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Studies of laparoscopic approaches in colorectal surgery support the use of such methods. Compared with the open approach, laparoscopy reduces rates of postoperative complications and decreases length of stay, while providing equivalent oncologic outcomes. Nevertheless, much of colorectal surgery is still being performed by the open approach. This may be partly due to the technical challenges in performing laparoscopy, particularly when working in narrow spaces such as the pelvis. Moreover, some of the current literature has questioned the oncologic outcomes after laparoscopic surgery for rectal cancer. Robotic surgery has been heralded as the minimally invasive tool that can overcome these challenges. It has the advantages that it provides a three dimensional image, uses wristed instruments, and has a computer interface that allows for fluid and accurate movements. Overall, current evidence suggests that robotics is safe and feasible in colorectal surgery, and that short term and long term outcomes are comparable to those seen for laparoscopic approaches. Studies on the costs of robotic surgery show conflicting results, and this is arguably one of the biggest disadvantages of its use. Because robotic surgery is a relatively new technology, few large high quality studies are available. Most of the published studies in this area consist of retrospective reviews, case matched studies, and national database reviews. Large randomized prospective studies are needed to further support its use.

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“…The robotic surgery helps reduce hospital stay and conversion rates and similar oncological outcomes in TME [17][18][19] . But recently, ROLARR (RObotic vs. LAparoscopic Resection for Rectal Cancer) trial revealed that robotic-assisted laparoscopic surgery do not confer an advantage over laparoscopic surgery in rectal cancer resection for TME [20] . However this trial did not address the e-TME/b-TME.…”

Section: Introductionmentioning

confidence: 99%

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.

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Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer

Abstract: isrctn.org Identifier: ISRCTN80500123.

Cited by 1,033 publications

References 31 publications

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

The role of robotics in colorectal surgery

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

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