Sphincter-Saving Robotic Total Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal Cancer

Abstract

Introduction: Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer. Materials and Methods: The study was conducted as a retrospective review of a prospectively maintained database. One-hundred-three robotic and 84 laparoscopic sphincter-saving total mesorectal excisions were performed by a single surgeon between January 2011 and January 2020. Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups. Results: The patients’ characteristics did not differ significantly between the two groups. Median operating time was longer in the robotic than in the laparoscopic group (180 minutes versus 140 minutes, p=0.033). Macroscopic grading of the specimen in the robotic group was complete in 96 (93.20%), near complete in four (3.88%) and incomplete in three (2.91%) patients. In the laparoscopic group, grading was complete in 37 (44.04%), near complete in 40 (47.61%) and incomplete in seven (8.33%) patients (p=0.03). The median length of follow up was 48 (9–102) months in the robotic, and 75.6 (11–113) months in the laparoscopic group. Overall, five-year survival was 87% in the robotic and 85.3% in the laparoscopic groups. Local recurrence rates were 3.8% and 7.14%, respectively, in the robotic and laparoscopic groups (p<0.05). Conclusion: Sphincter-saving robotic total mesorectal excision is a safe and feasible tool, which provides good mesorectal integrity and better local control in male patients with mid-low rectal cancer.

Robotic male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal cancer share similar specimen quality, complication rates and long-term oncological outcomes

“…In contrast, it is challenging to perform Lap-TME in male patients with mid-low RC without damaging the mesorectal envelope and obtaining negative DRM and CRM. This was con rmed in our previous study, comparing Lap-TME (n = 84) and Rob-TME (n = 103) techniques in male patients with mid-low RC [17].…”

“…Rob-TME provides improved mesorectum specimen compared to Lap-TME (complete mesorectum, 93.2% vs. 44.1%) in male patients with mid-low RC. Additionally, we found differences in conversion rates in male patients with RC concerning laparoscopic and robotic approaches (Lap-TME 3.5% versus Rob-TME 0%) [17]. Also, Rob-TME decreases the local recurrence rate (LRR) and improves OS (LRR: 3.8% vs. 7.1%, OS: 87.0% vs. 85.7%) [17].…”

“…However, the multivariate analysis demonstrated that male (adjusted OR = 2.44 [95% CI, 1.05 to 5.71]; p = 0.04) and obese (adjusted OR = 4.69 [95% CI, 2.08 to 10.58]; p < 0.001) patients were prone to signi cantly higher conversion rates in the laparoscopic group [29]. Additionally, our recent study showed that obese and male patients with mid-low RC undergoing Lap-TME had a higher conversion rate and poorer specimen integrity and long-term local control compared to those undergoing Rob-TME [17]. The 10-year follow-up of 217 standardized Lap-TME cases performed by a single surgeon (O.A.)…”

“…Chan et al also reported higher rates of LR (9.8% vs. 2.8%; p < 0.001) and reduced cumulative DFS in colorectal cancer patients who had a conversion from laparoscopic to open procedures [30]. In contrast, compared to laparoscopy, robotic RC surgery provided lower conversion rates, better preservation of sexual function, and oncological outcomes [31,32]. Also, the robotic approach has a shorter learning curve [33] and provides higher camera navigation quality than laparoscopy [34].…”

“…This technical improvement could result in a bene t for patients undergoing pelvic procedures both on oncological and functional outcomes [16]. Previously, we reported comparative results of laparoscopic TME (Lap-TME) versus robotic TME (Rob-TME) in male patients and demonstrated the superiority of the robotic approach on perioperative and long-term oncological results [17]. However, the technical advantage of the robotic platform may not be required for female patients who are generally characterized by a wider pelvis.…”