Short-term and long-term outcomes of robotic rectal surgery—from the real word data of 1145 consecutive cases in China

Abstract

Background Due to a limited patient sample size, substantial data on robotic rectal resection (RRR) is lacking. Here, we reported a large consecutive cases from the real word data to assess the safety and efficacy of RRR. Methods From September 2010 to June 2017, a total of 1145 consecutive RRR procedures were performed in patients with stage I-IV disease. We conducted an analysis based on information from a prospectively designed database to evaluate surgical outcomes, urogenital function, and long-term oncological outcomes. Results Of three types of RRR performed, 227 (24.2%) were abdominoperineal resections, 865 (75.5%) were anterior resections, and 3 (0.3%) were Hartmann. Conversion to an open procedure occurred in 5.9% of patients. The overall positive circumferential margin rate was 1.3%. Surgical complication rate and mortality were 16.2% and 0.8% within 30 days of surgery, respectively. Mean hospital stay after surgery and hospital cost were 6.3 ± 2.9 days and 10442.5 ± 3321.5 US dollars, respectively. Risk factors for surgical complications included male gender, tumor location (mid-low rectum), combined organ resection, and clinical T category (cT3-4). Urinary function and general sexual satisfaction decreased significantly 1 month after surgery for both sexes. Subsequently, both parameters increased progressively, and the values 1 year after surgery were comparable to those measured before surgery. At a median follow-up of 34.6 months, local recurrence and distant metastases occurred in 2.3% and 21.1% of patients, respectively. Conclusions Robotic rectal resection was safe with preserved urogenital function and arrived equivalent oncological outcomes in a nonselected group of patients with rectal cancer.

Robotic Surgery in Rectal Cancer

“…46 Chang et al reported no cases of incomplete mesorectum in their study of 1,145 cases of robotic rectal surgery, and Alfieri et al reported 98.3% of complete or near complete mesorectum. 26,61 These results, although comparable with those of LaTME, are very satisfactory and validate the safety of TME. 19,45 Functional Outcomes Urinary and sexual dysfunction are well-known sequelae, whether temporary or definitive, of rectal cancer surgery, due to unintentional injury or excision of pelvic autonomic nerves.…”

“…5 cm, were not significant in this study. 61 Tsukamoto et al, in a multi-center pilot phase II study with 50 cases, reported similar overall and severe complication rates (16% and 4%, respectively) with anastomotic leakage being the most common complication. The authors suggest that the low complication rate may be associated, among others, with the robotic system characteristics that allow better visualization and mobilization, precise dissection and safe reconstruction.…”

“…25 A study by Chang et al including 1,145 cases of robotic rectal cancer surgery reported a positive CRM rate of 1.3%, and Tang et al, in a series of 392 cases, reported 2.5% of CRM involvement, which supports the safety and feasibility of RoTME. 30,61 Moreover, no significant difference was found between these minimally invasive techniques and open surgery. 29,35,60,64…”

“…6,13,15,21,25,27,39,41,45,64 Chang et al, Tang et al and Kim et al, in their series of cases of robotic rectal surgery, reported a mean number of HLN of 17, 14.6 and 20.1, respectively, all greater than 12 HLN, ensuring the safety of RoTME. 16,30,61 When comparing robotic and laparoscopic approaches with open surgery, no significant difference was found. 29,35,60,64…”

Short-Term and Long-Term Outcomes in Mid and Low Rectal Cancer With Robotic Surgery

“…Some studies have reported no difference in the incidence of complications between robotic surgery and traditional laparoscopic surgery ( 9 ). Since 2010, the robotic surgery system has been gradually applied to radical surgery for mid and low rectal cancer due to its capability of producing high-definition images and its stable and flexible operation ( 10 ). These features are advantageous in distinguishing pelvic nerves, dissecting the anterior and lateral tissues, and suturing.…”