Robotic versus open total mesorectal excision for rectal cancer: Comparative study of short and long-term outcomes

Ghezzi, Tiago Leal; Luca, Fabrizio; Valvo, Manuela; Corleta, Oly Campos; Zuccaro, M.; Cenciarelli, Sabine; Biffi, R.

doi:10.1016/j.ejso.2014.02.235

Cited by 55 publications

(55 citation statements)

References 34 publications

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“…As mentioned previously, there are only a few studies comparing RCS and OCS [5][6][7][8][9][10][11] . Interestingly, these reports came exclusively from tertiary centers in Korea and Italy.…”

Section: Discussionmentioning

confidence: 99%

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Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer

Zawadzki¹,

Krzystek−Korpacka

Rząca³

et al. 2017

Dig Surg

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Purpose: The aim of this study was to compare robotic colorectal surgery (RCS) performed by a team having limited expertise in robotic surgery with open colorectal surgery (OCS) performed by experienced colorectal surgeons. Methods: This was a prospective comparative nonrandomized study. Results: Between March 2013 and June 2015, 79 patients with colon and rectal adenocarcinoma were enrolled into the study. Of these, 41 patients underwent OCS and 38 underwent RCS. The groups were comparable in terms of demographics and type of procedure. The RCS took significantly longer in the operating room than the OCS (222 vs. 141 min, p < 0.001). The rate of major complications was similar for both RCS and OCS (5.3 vs. 9.8%, p = 0.454). Wound infections were less frequent in the RCS group (10.5 vs. 29.3%, p = 0.039). The mean hospital stay was 1 day shorter in the RCS group than in the OCS group (5.7 vs. 6.7 days, p = 0.176). The lymph nodes harvested was comparable (14.7 RCS vs. 15.5 OCS, p = 0.596). Conclusions: This study confirmed that the surgical team with limited expertise in minimally invasive surgery can still safely introduce robotic surgery into their colorectal practice. When compared to the open approach, the robotic approach reduces hospital stay, as well as the rate of surgical site infection.

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Section: Discussionmentioning

confidence: 99%

“…Studies comparing RCS and open colorectal surgery (OCS) are less common. In fact, there are only 7 retrospective reports currently available in the literature that compare robotic and open large bowel resection [5][6][7][8][9][10][11] .…”

mentioning

confidence: 99%

Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer

Zawadzki¹,

Krzystek−Korpacka

Rząca³

et al. 2017

Dig Surg

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“…Then the remaining 42 articles were subjected to full-text examination and the following studies were further eliminated, including 24 articles without longterm oncologic outcomes, seven studies irrelevant to the comparison of DVSS versus LS/open surgery, and one plan. Finally, 10 eligible articles 5,11,[13][14][15][21][22][23][24][25] were included in the present meta-analysis.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…However, controversial results are presented. With regard to long-term outcomes, Ghezzi et al demonstrate that robotic total mesorectal excision (RTME) achieved a significantly reduced local recurrence rate (LRR) compared with open surgery mesorectal excision, 13 while similar effect on the 2-year disease-free survival (DFS) is found among open, laparoscopic, and robotic surgery.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery

Huang

Zhang

Wang

2016

International Journal of Advanced Robotic Systems

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In order to compare the curative effect of the Da Vinci surgical system (DVSS) with laparoscopic surgery (LS) or open surgery for colorectal resection, literature search was conducted in PubMed, Excerpt Medica Database (Embase), and Cochrane library up to January 15, 2016. Odds ratio (OR) and weighted mean difference with their corresponding 95% confidence intervals were used as effect size for evaluation of different outcomes. In total, 10 studies consisting of 2767 patients were included for the meta-analysis. As a result, there were no significant differences between DVSS and LS/open surgery in the long-term oncologic outcomes (p > 0.05). However, DVSS achieved a significantly lower length of hospital stay and estimated blood loss (EBL), but a longer operation time. Moreover, DVSS showed a significantly reduced conversion to open surgery than LS (OR ¼ 0.19, 95% confidence interval: 0.08-0.48). Subgroup analysis indicated that DVSS had different results in rectal adenocarcinoma and colon cancer subgroups on outcomes of conversion to open surgery and operation time. DVSS is superior to LS/open surgery in length of hospital stay and EBL, but needs longer operation time. Long-term outcomes of DVSS are comparable with the other approaches. From long-term perspective, DVSS has an equivalent effect to the other two techniques.

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“…197,198 Other studies concluded that the quality of TME carried out robotically was encouraging, if not superior, to that achieved by traditional laparoscopy, in terms of prevention of sexual and urinary dysfunction, and intraoperative blood loss. 199,200 When considering locoregional recurrences, the distance of recurrences, and total recurrences occurring, Kwak et al 201 did not find any significant difference between the two approaches. Moreover, Kang et al 202 reported no significant differences in 2-year survival following robotic, laparoscopic, and open group rectal surgeries.…”

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confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

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Abstract:The rapid diffusion of new technologies in surgery, together with high expectations of both patients and the mass media, has led to many gastrointestinal procedures being approached using robots. Robotic technology seems to resolve many of the drawbacks of laparoscopic advanced procedures, such as anastomotic reconstructions, accurate lymphadenectomy, and vascular sutures. In addition, a deeper tridimensional steady vision with excellent high definition, the EndoWrist technology offering seven degrees of freedom, tremor filtration, scaled motion, optimal working ergonomics, and avoidance of the 'fulcrum effect', are the main strengths of the da Vinci ® system. The use of near-infrared technology and the possibility of tutoring through a double-console will most likely add many more advantages of this technology over laparoscopy alone. However, none of the gastrointestinal robotic interventions has reached a level of evidence-based efficacy that enables it to be routinely applied. The main limitations of robotic gastrointestinal procedures are represented by the learning curve, the higher costs of robotic surgery compared to traditional and laparoscopic surgery, and the longer operation times, including setup and organizational troubles. Moreover, while the limits of robotics for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies, and long-term follow-up is still lacking. On the other hand, a word of caution should be presented on the adoption of robotics in too many surgical units without the correct and formal technical background and third-party control to guarantee the best outcomes for patients at minimum risk. Therefore, the robotic treatment of gastrointestinal diseases requires a thorough analysis of the published evidence, in order to determine the correct indications and patient selection. This review aims to examine the evidence for the use of robotic surgery in both malignancies and benign disease arising from the gastrointestinal area. Future developments in robotics and ongoing areas of research are also analyzed.

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Robotic versus open total mesorectal excision for rectal cancer: Comparative study of short and long-term outcomes

Cited by 55 publications

References 34 publications

Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer

Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer

Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery

Gastrointestinal robotic surgery: challenges and developments

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