Robotic and robotic-assisted vs Laparoscopic rectal cancer surgery: A meta-analysis of short-term and long-term results

Tong, Guojun; Zhang, Gui-Yang

doi:10.1016/j.asjsur.2021.08.053

Cited by 5 publications

(5 citation statements)

References 72 publications

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“…The randomized trial by Kim et al found no significant difference in circumferential resection margin (CRM) positivity rates between robotic and laparoscopic proctectomy (7.7% vs 13.2%, p = 0.513) [18]. Similar CRM positivity was reported in other studies, including the meta-analysis by Li et al which found no difference between robotic and laparoscopic surgery after pooling 7 RCTs (RR 1.47, 95% CI 0.53-4.05, p = 0.46) [15,16].…”

Section: Oncologic Outcomessupporting

confidence: 69%

“…Additional factors that contribute to higher costs for robotic surgery include longer operative times, the need for repairs/replacements of robotic arms and instruments, purchase and maintenance of the robotic system itself, and increased utilization of operating room resources [15,24]. In our experience we found that after the first 5 cases, robotic proctectomy had similar overall costs compared to open surgery when a cost-conscious approach was used, despite longer operative times [27••].…”

Section: Cost Effectivenessmentioning

confidence: 98%

“…Most studies report comparable lengths of hospital stay between robotic and laparoscopic rectal surgery, averaging 5-12 days [15,18]. Both minimally invasive methods result in significantly shorter hospitalization compared to open surgery [21,22].…”

Section: Short-term Outcomesmentioning

confidence: 99%

“…However, most surgeons receive no formal credentialing or robotic training beyond their laparoscopic colorectal experience [15,22]. One study found only 18% of robotic rectal surgeons had formal credentialing protocols [15].…”

Section: Training and Adoptionmentioning

confidence: 99%

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Robotic Rectal Cancer Surgery: Current Controversies

Alipouriani,

Gorgun

2024

Curr Surg Rep

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Purpose of Review This review evaluates the current literature on robotic surgery for rectal cancer and discusses ongoing controversies related to outcomes, training, adoption, and cost-effectiveness. Recent Findings Robotic rectal surgery is associated with some benefits in short-term outcomes such as lower conversions compared to laparoscopy but also substantially higher costs. Data on long-term oncologic outcomes are still limited. Studies are inconsistent regarding benefits in margin positivity and other metrics. There is significant variability in training practices and adoption rates globally. Summary Robotic rectal surgery is increasingly utilized, especially for low rectal cancers where laparoscopy is more challenging. It allows more patients to undergo minimally invasive total mesorectal excision. However, benefit over laparoscopy is unclear for less complex cases. Ongoing controversies exist related to true outcomes, optimal training, cost-effectiveness, and credentialing of surgeons. Further data from high-quality trials are needed to better determine the definitive role of robotic platforms.

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Section: Oncologic Outcomessupporting

confidence: 69%

Section: Cost Effectivenessmentioning

confidence: 98%

Section: Short-term Outcomesmentioning

confidence: 99%

Section: Training and Adoptionmentioning

confidence: 99%

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Robotic Rectal Cancer Surgery: Current Controversies

Alipouriani,

Gorgun

2024

Curr Surg Rep

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“…The robotic surgical system provides numerous advantages, such as high-definition three-dimensional vision with up to 10× magnification, stable traction by robot arms, and the availability of articulatory instruments and a surgeon-controlled camera platform. Compared with open surgical and conventional laparoscopic approaches for patients with rectal cancers, robotic-assisted rectal surgery (RRS) appears to be favorable in terms of perioperative and short-term oncological outcomes [ 10 , 11 , 12 , 13 , 14 , 15 ]. Studies on RRS in Taiwan have demonstrated that RRS is safe and feasible for high dissection and low or selective ligation of the inferior mesentery artery, for the single-docking technique, in cases of long intervals between the completion of radiotherapy and robotic-assisted surgery, and for older adult patients aged >70 years [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Safety and Effectiveness of Robotic-Assisted Surgery in Patients with Rectal Cancer: Real-World Experience over 8 Years of Multiple Institutions with High-Volume Robotic-Assisted Surgery

Huang

Wei

Chen

et al. 2022

Cancers

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The perioperative and short-term oncological outcomes of robotic-assisted rectal surgery (RRS) are unclear. This retrospective observational study enrolled patients with rectal adenocarcinoma undergoing RRS from three high-volume institutions in Taiwan. Of the 605 enrolled patients, 301 (49.75%), 176 (29.09%), and 116 (19.17%) had lower, middle, and upper rectal cancers, respectively. Low anterior resection (377, 62.31%) was the most frequent surgical procedure. Intraoperative blood transfusion was performed in 10 patients (2%). The surgery was converted to an open one for one patient (0.2%), and ten (1.7%) patients underwent reoperation. The overall complication rate was 14.5%, including 3% from anastomosis leakage. No deaths occurred during surgery and within 30 days postoperatively. The positive rates of distal resection margin and circumferential resection margin were observed in 21 (3.5%) and 30 (5.0%) patients, respectively. The 5-year overall and disease-free survival rates for patients with stage I–III rectal cancer were 91.1% and 86.3%, respectively. This is the first multi-institutional study in Taiwan with 605 patients from three high-volume hospitals. The overall surgical and oncological outcomes were equivalent or superior to those estimated in other studies. Hence, RRS is an effective and safe technique for rectal resection in high-volume hospitals.

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