Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short‐term Outcomes and Morbidity

Taylor, James P.; Stem, Miloslawa; Althumairi, Azah; Gearhart, Susan L.; Safar, Bashar; Fang, Sandy H.; Efron, Jonathan E.

doi:10.1007/s00268-020-05560-9

Cited by 8 publications

(6 citation statements)

References 58 publications

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“…Operative time (min). Twelve studies [11][12][13][14][15][16][17][18][19][20][21][22] reported this outcome. Random-effects models showed that the robotic approach was statistically significantly different from the laparoscopic approach and that the laparoscopic approach was superior (P < .01, MD = 23.14 [6.89, 39.40]).…”

Section: Results Of Individual Studiesmentioning

confidence: 99%

“…We hypothesize that the reason for this phenomenon may be the learning curve of robotic surgery. All studies except 3 19,20,24 reported that robotic surgery was performed by the same surgeon or the same surgical team. In studies with a relatively small sample size of the R-LAR group, the surgeon or team performing the surgery was generally at the front of the learning curve, where unskilled operations may be time-consuming, as opposed to studies with a medium or large sample size of R-LAR group, where the surgeon performing the surgery may have been on a different technical learning curve.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Operative Time Between Robotic and Laparoscopic Low Anterior Resection for Rectal Cancer:A Systematic Review and Meta-Analysis

Chen

et al. 2023

Surg Innov

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Background. Previous studies have shown that the robotic approach has better perioperative outcomes but longer operative time than the laparoscopic approach for patients undergoing low anterior resection. However, the impact of the learning curve on operative time is controversial. This study aimed to evaluate operative time and associated outcomes by comparing robotic low anterior resection (R-LAR) with laparoscopic low anterior resection (L-LAR). Methods. Pubmed, Embase, Cochrane Library, Ovid, Web of Science, and CNKI databases were interrogated from the inception to April 2021. Two authors screened all records through full-text reading and extracted and synthesized the data using a structured table. A random-effect model was used to evaluate heterogeneity. Meta-analysis was implemented by R 4.1.1 meta-package. Results. Twelve studies (1684 patients) were included in the present review. R-LAR compare to L-LAR approach has significant differences in operative time (min) (MD = 23.14, 95% CI: 6.89-39.40, P < .01), blood loss (mL) (MD = −42.66, 95% CI: [−68.51, −16.81], P < .01), number of lymph nodes harvested (MD = 1.06, 95% CI: [.16; 1.97], P < .05). Sensitivity analysis of the number of lymph nodes harvested indicated that the overall effect might not be stable. Subgroup analysis showed that mean age and sample size of R-LAR were 2 important factors affecting the estimation. Conclusions. Our results presented a prolonged operative time with the robotic approach compared to laparoscopy, but this gap diminished as the sample size increased. It might be more timesaving once surgeons are familiar with surgical robots.

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Section: Results Of Individual Studiesmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Operative Time Between Robotic and Laparoscopic Low Anterior Resection for Rectal Cancer:A Systematic Review and Meta-Analysis

Chen

et al. 2023

Surg Innov

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“…Although the expected rate of APE and definitive colostomy in specialized units for the treatment of rectal cancer is around 15%, there are reports in the literature of AAP rates as high as 50% in these cases 2 . A retrospective study of 4,471 patients included in the database of the American College of Surgeon’s National Surgical Quality Improvement Program between 2016 and 2018 and conducted by Taylor et al 8 found APE rates in the US of impressive 52.2%. Lack of an adequate technique and the difficulty of performing a low colorectal or coloanal anatomosis meant that APE became adopted liberally until the end of the last century 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Many surgeons and other cancer specialists see APE as a radical procedure used to reduce the local recurrence rate. However, several papers from major centers have suggested that ideally APE should be done in no more than 15% of all cases of rectal cancer and that many of the cancers currently treated by APE, based on older concepts, could be treated by LAR using the ideas of TME with intersphincteric resection, no permanent colostomy and respect for oncological principles 1 , 2 , 4 , 5 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision

Faier

Queiroz

Filho

et al. 2023

Rev. Col. Bras. Cir.

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Objectives: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate of abdominoperineal excision (APE). Methods: we enrolles patients with extraperitoneal rectal cancer undergoing TME or TME+APE. Patients with mid rectal tumors underwent TME, and patients with tumors of the lower rectum and no criteria for APE underwent TME and intersphincteric resection. Those in which the intersphincteric space was invaded and in those with a free distal margin less than 1cm or a tumor free radial margin were unattainable underwent APE or extralevator abdominoperineal excision (ELAPE). We assessed local recurrence rates, overall survival and involvement of the radial margin. Results: sixty (89.6%) patients underwent TME and seven (10.4%) TME + APE, of which five underwent ELAPE. The local recurrence, in pacientes undergoing TME+LAR, was 3.3% and in patients undergoing APE, 14.3%. The local recurrence rate (p=0.286) or the distant recurrence rate (p=1.000) was similar between groups. There was no involvement of radial margins. Survival after 120 months was similar (p=0.239). Conclusion: rectal malignancies, including those located in the low rectum, may be surgically treated with a low rate of APE without compromising oncological principles and with a low local recurrence rates.

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“…This minimally invasive approach provides striking benefits with regard to incisional morbidity and postoperative scarring and is likely equivalent to traditional open resection from an oncologic perspective. 1 2 Robotic surgery has recently been introduced as a new approach in achieving minimally invasive APR. Developed over the past two decades, robotic surgery offers advantages of enhanced precision, tremor elimination, motion scaling, high resolution, and three-dimensional optics.…”

Section: Introductionmentioning

confidence: 99%

Robotic Rectus Abdominis Harvest for Pelvic Reconstruction after Abdominoperineal Resection

et al. 2023

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The use of robotic surgical systems to perform abdominoperineal resection (APR) has recently become more prevalent. This minimally invasive approach produces fewer scars and potentially less morbidity for the patient. The rectus abdominis muscle is often used for reconstruction after APR if primary closure is not feasible or the surgical site is at high risk of wound complications. Since the traditional open harvest of this flap creates large incisions that negate the advantages of minimally invasive APR, there has been growing interest in harvesting the rectus abdominis in a similarly robotic fashion. This article reviews the technique, benefits, and limitations of this robotic technique. Compared to the traditional open harvest, robotic harvest of the rectus abdominis leaves smaller scars, provides technical benefits for the surgeon, and offers possible morbidity benefits for the patient. These advantages should be weighed against the added expense and learning curve inherent to robotic surgery.

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Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short‐term Outcomes and Morbidity

Cited by 8 publications

References 58 publications

Comparison of Operative Time Between Robotic and Laparoscopic Low Anterior Resection for Rectal Cancer:A Systematic Review and Meta-Analysis

Comparison of Operative Time Between Robotic and Laparoscopic Low Anterior Resection for Rectal Cancer:A Systematic Review and Meta-Analysis

Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision

Robotic Rectus Abdominis Harvest for Pelvic Reconstruction after Abdominoperineal Resection

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