Long-term oncological outcomes in robotic versus laparoscopic approach for rectal cancer: A systematic review and meta-analysis

Qiu, Hua; Yu, Dong-Jun; Ye, Shanping; Shan, Renfeng; Ai, Junhua; Shi, Jun

doi:10.1016/j.ijsu.2020.03.009

Cited by 34 publications

(24 citation statements)

References 25 publications

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“…Compared to the patients with LRR, there were more male patients in the RR group [65% (62-67) versus 61% (59-62)] and the proportion of distal tumors < 5 cm from the anal verge was higher [44% (41-47) versus 41% (39)(40)(41)(42)]. Conversion rate was lower in the robotic group [4% (3-5) versus 7% (6)(7)(8)]. Conversion was termed strategic in 72% (60-85) in RR, and 66% (60-72) after LRR (34/47 versus 162/244, P = 0.499) and the other conversion were reactive.…”

Section: Resultsmentioning

confidence: 99%

Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study

et al. 2022

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Aim An increasing number of centers have implemented a robotic surgical program for rectal cancer. Several randomized controls trials have shown similar oncological and postoperative outcomes compared to standard laparoscopic resections. While introducing a robot rectal resection program seems safe, there are no data regarding implementation on a nationwide scale. Since 2018 robot resections are separately registered in the mandatory Dutch Colorectal Audit. The present study aims to evaluate the trend in the implementation of robotic resections (RR) for rectal cancer relative to laparoscopic rectal resections (LRR) in the Netherlands between 2018 and 2020 and to compare the differences in outcomes between the operative approaches. Methods Patients with rectal cancer who underwent surgical resection between 2018 and 2020 were selected from the Dutch Colorectal Audit. The data included patient characteristics, disease characteristics, surgical procedure details, postoperative outcomes. The outcomes included any complication within 90 days after surgery; data were categorized according to surgical approach. Results Between 2018 and 2020, 6330 patients were included in the analyses. 1146 patients underwent a RR (18%), 3312 patients a LRR (51%), 526 (8%) an open rectal resection, 641 a TaTME (10%), and 705 had a local resection (11%). The proportion of males and distal tumors was higher in the RR compared to the LRR. Over time, the proportion of robotic procedures increased from 15% (95% confidence intervals (CI) 13–16%) in 2018 to 22% (95% CI 20–24%) in 2020. Conversion rate was lower in the robotic group [4% (95% CI 3–5%) versus 7% (95% CI 6–8%)]. Anastomotic leakage rate was similar with 16%. Defunctioning ileostomies were more common in the RR group [42% (95% CI 38–46%) versus 29% (95% CI 26–31%)]. Conclusion Rectal resections are increasingly being performed through a robot-assisted approach in the Netherlands. The proportion of males and low rectal cancers was higher in RR compared to LRR. Overall outcomes were comparable, while conversion rate was lower in RR, the proportion of defunctioning ileostomies was higher compared to LRR.

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Section: Resultsmentioning

confidence: 99%

Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study

et al. 2022

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“…In der bisher größten randomisierten klinischen Studie zum Vergleich der roboterassistierten vs. konventionellen laparoskopischen Rektumresektion (ROLARR Randomized Clinical Trial) zeigte sich hinsichtlich der definierten primären und sekundären Outcome-Parameter allerdings kein signifikanter Unterschied 16 . In mehreren Metaanalysen von randomisierten und nicht randomisierten Studien, welche die roboterassistierte mit der konventionellen laparoskopischen Rektumchirurgie vergleichen, zeigt sich, dass die roboterassistierte der konventionellen Laparoskopie hinsichtlich der meisten Kurzzeit- und Langzeitergebnisse ebenbürtig ist 17 , 18 . Des Weiteren deuten vorliegende Metaanalysen daraufhin, dass die Konversionsrate bei der robotischen Chirurgie niedriger ist, es zu weniger intraoperativem Blutverlust kommt, jedoch die Operationszeit zumeist signifikant länger ist 19 , 20 .…”

Section: Kolorektale Chirurgieunclassified

Robotik – was geht in der Chirurgie?

Hillebrandt¹,

Schmelzle²,

Sauer³

et al. 2022

OP-JOURNAL

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ZusammenfassungDie roboterassistierte Chirurgie hat sich in den letzten Jahren deutlich weiterentwickelt und wurde in immer mehr Teilbereichen der Chirurgie als fester Bestandteil des operativen Spektrums implementiert. Dieser Beitrag legt den aktuellen Stand der roboterassistierten Chirurgie in Bereichen der Allgemein-, Viszeral- und Thoraxchirurgie unter Berücksichtigung der aktuellen Literatur dar.

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“…Retrospective studies and meta-analyses have shown that compared with laparoscopic surgery, robotic surgery could improve surgical quality, reduce circumferential resection margin (CRM) positivity and postoperative complications, promote postoperative recovery, and protect urinary and sexual function, [4][5][6] with similar long-term survival. [7][8][9] However, the quality of these studies is not high and is insufficiently persuasive. Recently, in the multicenter randomized controlled ROLARR trial, 10 robotic surgery failed to achieve the significant superiority in open conversion rate as the primary outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Robotic techniques might improve the quality of surgery because of the three‐dimensional vision, stable camera platform, and flexible robotic arms. Retrospective studies and meta‐analyses have shown that compared with laparoscopic surgery, robotic surgery could improve surgical quality, reduce circumferential resection margin (CRM) positivity and postoperative complications, promote postoperative recovery, and protect urinary and sexual function, 4–6 with similar long‐term survival 7–9 …”

Section: Introductionmentioning

confidence: 99%

Robotic versus laparoscopic abdominoperineal resections for low rectal cancer: A single‐center randomized controlled trial

Feng

Tang

Zhang

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Robotic surgery for rectal cancer is gaining popularity, but persuasive evidence on reducing surgical trauma is still lacking. This study compared robotic and laparoscopic abdominoperineal resections (APRs) for the risk of postoperative complications in low rectal cancer. Methods Between December 2013 and 2016, patients with rectal cancer ≤5 cm from anal verge, cT1‐T3 N0‐1, or ycT1‐T3 Nx stage, and no distant metastases were enrolled in a single‐center, randomized, controlled trial. Eligible patients were randomly allocated to robotic or laparoscopic APRs at 1:1 ratio. The primary outcome was 30‐day postoperative complication rate (Clavien−Dindo grade II or higher) of the intent‐to‐treat population. The trial registration number is NCT01985698 (http://www.clinicaltrials.gov). Results Totally 347 eligible patients were enrolled: 174 in robotic and 173 in laparoscopic group. Robotic APRs significantly reduced postoperative complication rate (13.2% vs. 23.7%, p = 0.013), also reduced open conversion rate (0% vs. 2.9%, p = 0.030), intraoperative hemorrhage (median, 100 vs. 130 ml; p < 0.001), 30‐day readmission rate (2.3% vs. 6.9%; p = 0.044), postoperative hospital stay (median, 5.0 vs. 7.0 days; p < 0.001), and improved urinary and sexual function. No significant difference was observed in long‐term oncological outcomes. Conclusions Compared with laparoscopic APRs, robotic APRs significantly reduced surgical trauma and promoted postoperative recovery.

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Long-term oncological outcomes in robotic versus laparoscopic approach for rectal cancer: A systematic review and meta-analysis

Cited by 34 publications

References 25 publications

Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study

Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study

Robotik – was geht in der Chirurgie?

Robotic versus laparoscopic abdominoperineal resections for low rectal cancer: A single‐center randomized controlled trial

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