Outcomes of Robot-Assisted Surgery in Rectal Cancer Compared with Open and Laparoscopic Surgery

Abstract

With increasing trends for the adoption of robotic surgery, many centers are considering changing their practices from open or laparoscopic to robot-assisted surgery for rectal cancer. We compared the outcomes of robot-assisted rectal resection with those of open and laparoscopic surgery. We searched Medline, Web of Science, and CENTRAL databases until October 2022. All randomized controlled trials (RCTs) and prospective studies comparing robotic surgery with open or laparoscopic rectal resection were included. Fifteen RCTs and 11 prospective studies involving 6922 patients were included. The meta-analysis revealed that robotic surgery has lower blood loss, less surgical site infection, shorter hospital stays, and higher negative resection margins than open resection. Robotic surgery also has lower conversion rates, lower blood loss, lower rates of reoperation, and higher negative circumferential margins than laparoscopic surgery. Robotic surgery had longer operation times and higher costs than open and laparoscopic surgery. There were no differences in other complications, mortality, and survival between robotic surgery and the open or laparoscopic approach. However, heterogeneity between studies was moderate to high in some analyses. The robotic approach can be the method of choice for centers planning to change from open to minimally invasive rectal surgery. The higher costs of robotic surgery should be considered as a substitute for laparoscopic surgery (PROSPERO: CRD42022381468).

Robot‐assisted laparoscopic abdominoperineal resection for anal canal cancer associated with Crohn's disease: A case report

“…A large meta-analysis by Khajeh et al showed that robotic surgery had better outcomes than the laparoscopic approach in terms of bleeding, the need for reoperation, and complete tumor resection. 8 Robotic rectal resection has a low rate of positive circumferential resection margins, a high rate of appropriate total mesorectal excision, and good overall and disease-free survival. 9 Even when focusing on abdominoperineal resection, robotic surgery has demonstrated better short-term outcomes than laparoscopic surgery, suggesting that it could be a useful approach.…”

“…Several studies have supported the safety and efficacy of robotic surgery for rectal cancer. A large meta‐analysis by Khajeh et al showed that robotic surgery had better outcomes than the laparoscopic approach in terms of bleeding, the need for reoperation, and complete tumor resection 8 . Robotic rectal resection has a low rate of positive circumferential resection margins, a high rate of appropriate total mesorectal excision, and good overall and disease‐free survival 9 .…”

Prince and princesses: The current status of robotic surgery in surgical oncology

“…Open resection was associated with a higher rate of surgical site infection compared to the robotic approach without a difference in leak rate. Oncologic resection was superior in the robotic approach, which had a higher rate of R0 resections ( p = 0.04), negative circumferential resection margin ( p = 0.03), and number of LN examined ( p = 0.02); however, there was no difference in DFS or OS 121 …”

“…Oncologic resection was superior in the robotic approach, which had a higher rate of R0 resections (p = 0.04), negative circumferential resection margin (p = 0.03), and number of LN examined (p = 0.02); however, there was no difference in DFS or OS. 121…”

A systematic review and meta-analysis of minimally invasive versus conventional open proctectomy for locally advanced colon cancer

“…[6][7][8] Although many articles have been published on the comparison of early and middle rectal cancer. [9][10][11] There are few studies on locally advanced rectal cancer. [10] The treatment plan and results of the 2 stages of rectal cancer are significantly different.…”