Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer

Yamaguchi, Takahiro; Kinugasa, Yusuke; Shiomi, Akio; Kagawa, Hiroyasu; Yamakawa, Yushi; Furutani, Akira; Manabe, Shoichi; Yamaoka, Yusuke; Hino, Hitoshi

doi:10.1007/s00464-018-6197-x

Cited by 65 publications

(47 citation statements)

References 27 publications

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“…Furthermore, we evaluated the parameters for predicting recurrence by DFS, and it showed surgical methods, CRM involvement, and histologic grade were independent factors for recurrence in these patients. Our RS group had significantly lower postoperative local recurrence and better DFS compared with other groups, which was consistent with a previous 54-month follow-up study conducted by Yamaguchi et al [30]. The probable reason for this may be the less CRM involvement in RS patients.…”

Section: Discussionsupporting

confidence: 91%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

Chen

Huang

et al. 2020

BMC Surg

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Background: Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation. Methods: This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months. Results: Upon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS. Conclusions: This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

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Section: Discussionsupporting

confidence: 91%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

Chen

Huang

et al. 2020

BMC Surg

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“…The postoperative rectal cancer recurrence rate has been significantly reduced, and the postoperative survival rate has been significantly improved since Heald and Ryall presented the concept of a TME [3,13] . In 2009, Hohenberger et al proposed the standardized application of the CME in the radical resection of colon cancer.…”

Section: Discussionmentioning

confidence: 99%

Safety and Short-term Efcacy of a Laparoscopic Complete Mesocolic Excision for the Surgical Treatment of Right Hemicolon Cancer

Li¹,

Meng²,

Chen³

2018

Clin Surg Res Commun

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Objective: This study was designed to evaluate the safety and short-term efficacy of a laparoscopic complete mesocolic excision (CME) in patients with right hemicolon cancer. Methods: A total of 88 patients with right hemicolon cancer were retrospectively reviewed. Forty patients underwent laparoscopic CMEs, and 48 patients underwent open CMEs. The clinical data were analyzed and the outcomes were compared between the two groups. Result: There was no significant difference between the laparoscopic CME group and open CME group with regard to the harvested lymph node number (16.60±3.20 vs. 15.33±3.10, respectively, P=0.060), hospital stay length (18.15±5.17 days vs. 17.21±4.47 days, respectively, P=0.360), and postoperative complications (10.0% vs. 10.4%, respectively, P=0.950). The operation time in the laparoscopic CME group (3.02±0.55 hours) was significantly longer than that in the open CME group (2.58±0.50 hours, P=0.004). The time to first flatus (3.28±0.75 days vs 3.92±0.71 days, respectively, P=0.001) and getting out of bed time (1.95±0.75 days vs 3.54±0.71 days, respectively, P=0.001) were both earlier in the laparoscopic CME group than in the open CME group. Conclusion: A laparoscopic CME is a safe and effective minimally invasive surgery for the treatment of right hemicolon cancer.

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“…In addition, Yamaguchi et al. showed an excellent 5‐year local relapse‐free survival rate of 98.6% in robotic LLND compared with 90.9% in open LLND ( P = 0.029) …”

Section: Extended Proceduresmentioning

confidence: 99%

“…Only a few studies have reported on long‐term outcomes because of the comparatively short history of RALS for rectal cancer. RALS was compared with CLS in four studies and with OS in two studies . Kim et al.…”

Section: Long‐term Outcomesmentioning

confidence: 99%

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Matsuyama

Kinugasa

Nakajima

et al. 2018

Annals of Gastroent Surgery

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Interest in minimally invasive surgery has increased in recent decades. Robotic‐assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual‐console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.

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Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer

Abstract: The short- and long-term outcomes indicated that RALLD may be a useful modality for locally advanced low rectal cancer.

Cited by 65 publications

References 27 publications

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

Safety and Short-term Efcacy of a Laparoscopic Complete Mesocolic Excision for the Surgical Treatment of Right Hemicolon Cancer

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

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