Minimal access surgery for rectal cancer: an update

Hui, Vanessa W.; Guillem, José G.

doi:10.1038/nrgastro.2013.203

Cited by 18 publications

(8 citation statements)

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“…Regarding minimally invasive rectal cancer surgery, we are a step back to laparoscopic colectomy, either in terms of diffusion of the procedure either in terms of level of evidence (56). …”

Section: Discussion and Personal Remarksmentioning

confidence: 99%

Laparoscopic and Robotic Total Mesorectal Excision in the Treatment of Rectal Cancer. Brief Review and Personal Remarks

et al. 2014

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The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.

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“…Regarding minimally invasive rectal cancer surgery, we are a step back to laparoscopic colectomy, either in terms of diffusion of the procedure either in terms of level of evidence (56). …”

Section: Discussion and Personal Remarksmentioning

confidence: 99%

Laparoscopic and Robotic Total Mesorectal Excision in the Treatment of Rectal Cancer. Brief Review and Personal Remarks

et al. 2014

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“…LRC is already widely diffused and provides several well-known advantages compared to open right colectomy: Reduction of post-operative complications, blood loss, hospital stay,[ 34 ] faster recovery, lower rate of wound infection. [ 35 ] Whereas robotic rectal surgery has been well analysed,[ 36 ] only few single institutional studies were published comparing laparoscopic versus RRC, with controversial results. Some authors suggest that the robotic approach has potential advantages in terms of less post-operative length of stay and less peri-operative complications.…”

Section: Discussionmentioning

confidence: 99%

Robotic right colectomy: A worthwhile procedure? Results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy

et al. 2015

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BACKGROUND:Robotic right colectomy (RRC) is a complex procedure, offered to selected patients at institutions highly experienced with the procedure. It is still not clear if this approach is worthwhile in enhancing patient recovery and reducing post-operative complications, compared with laparoscopic right colectomy (LRC). Literature is still fragmented and no meta-analyses have been conducted to compare the two procedures. This work aims at reducing this gap in literature, in order to draw some preliminary conclusions on the differences and similarities between RRC and LRC, focusing on short-term outcomes.MATERIALS AND METHODS:A systematic literature review was conducted to identify studies comparing RRC and LRC, and meta-analysis was performed using a random-effects model. Peri-operative outcomes (e.g., morbidity, mortality, anastomotic leakage rates, blood loss, operative time) constituted the study end points.RESULTS:Six studies, including 168 patients undergoing RRC and 348 patients undergoing LRC were considered as suitable. The patients in the two groups were similar with respect to sex, body mass index, presence of malignant disease, previous abdominal surgery, and different with respect to age and American Society of Anesthesiologists score. There were no statistically significant differences between RRC and LRC regarding estimated blood loss, rate of conversion to open surgery, number of retrieved lymph nodes, development of anastomotic leakage and other complications, overall morbidity, rates of reoperation, overall mortality, hospital stays. RRC resulted in significantly longer operative time.CONCLUSIONS:The RRC procedure is feasible, safe, and effective in selected patients. However, operative times are longer comparing to LRC and no advantages in peri-operative and post-operative outcomes are demonstrated with the use of the robotic surgical system.

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“…With proper patient selection and sufficient practice, robotic TME offers an effective treatment modality in the hands of an experienced rectal surgeon, although these advantages come at a higher financial cost. 16,62,74,97,98,105,112-118 If current trends continue, the costs associated with robotic surgery will likely decrease, owing to economies of scale, improved instrument design, and increased proficiency of the operating teams. 119…”

Section: Robotic Colorectal Surgerymentioning

confidence: 99%