The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study

Abstract

BackgroundColorectal cancer is one of the most common cancers worldwide. Laparoscopic colorectal surgery (LCRS) is a frequently used modality. A new development in minimally invasive surgery is robot-assisted colorectal surgery (RACRS).MethodsProspectively collected data of 378 consecutive patients who underwent RACRS or LCRS for stage I–III colorectal cancer from Dec 2014 to Oct 2017 were analyzed. Primary outcome was oncological outcome (radical margins, number of retrieved lymph nodes, locoregional recurrence). Secondary outcomes were distant metastases, overall and disease-free survival, operation time, conversion, length of hospital stay, and intra- and post-operative complications.Results206 RACRS (129 colon and 77 rectal) and 172 LCRS (138 colon and 34 rectal) procedures were included. Baseline characteristics were similar. Overall median follow-up time was 15 months (0.2–36). Oncological outcome was similar. In colon cancer, radical margins were achieved in 99.3% in RACRS group versus 98.6% in LCRS group (p = 0.60), the average number of harvested lymph nodes was 16 ± 6 versus 18 ± 7 (p = 0.16), and locoregional recurrence rate in 24 months was 3.8% vs 3.8% (p = 0.99), respectively. In rectal cancer, radical margins were achieved in 89.6% in RACRS group versus 94.3% in LCRS group (p = 0.42), the average number of harvested lymph nodes was 16 ± 8 versus 15 ± 4 (p = 0.51), and locoregional recurrence rate in 24 months was 9.5 versus 5.6% (p = 0.42), respectively. Incidence of metastasis, survival rates, operation time, length of hospital stay, and number of severe post-operative complications measured by Clavien–Dindo scores did not differ between RACRS and LCRS groups. Conversion and intra-operative complication rates were significantly lower in the RACRS group as compared to the LCRS group (3% vs 9%, p = 0.008 and 2% vs 8%, p = 0.003, respectively).ConclusionRACRS is safe in the treatment of patients with stage I–III colorectal cancer. Oncological outcome did not differ between RACRS and LCRS groups. RACRS had lower conversion and intra-operative complication rates.

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

“…Although the results in detail might vary depending on the studies, the recent comparative studies between laparoscopic and robotic TME for rectal cancer showed overall comparable clinical outcomes (Table 1). [40][41][42][43][44][45][46][47][48] In 2008, Baik et al 40 reported a pilot randomized controlled study for comparing robotic and laparoscopic tumor-specific mesorectal excision (TSME) with a small population, the results showed that the mean operative time was not significantly different between the two groups (217.1±51.6 vs. 204.3±51.9, p=0.477). According to Park et al 42 and Polat et al 48 , the operative time also reported no difference.…”

“…[40][41][42][43][44][45][46][47][48] In 2008, Baik et al 40 reported a pilot randomized controlled study for comparing robotic and laparoscopic tumor-specific mesorectal excision (TSME) with a small population, the results showed that the mean operative time was not significantly different between the two groups (217.1±51.6 vs. 204.3±51.9, p=0.477). According to Park et al 42 and Polat et al 48 , the operative time also reported no difference. However, except for those studies, the other studies have shown that robotic rectal surgery not only showed longer operative time, [43][44][45][46][47] but also shorter operative time 41 than laparoscopic rectal surgery.…”

“…The length of hospital stay (LOS) of robotic TME is generally similar or slightly shorter than laparoscopic surgery. [40][41][42][43][44][45][46][47][48] Baik et al 40 presented the mean LOS of robotic rectal surgery was shorter than the laparoscopic approach (6.9±1.3 days vs 8.7 ±1.3 days, p<0.001) in the short-term follow up. Park et al 42 also reported similar results regarding LOS in long-term fol-low up (5.86±1.43 days vs 6.54±2.65 days, p=0.035).…”

“…The complication rates of robotic TME were ranged from 14.3% to 47.6%, while those of laparoscopic TME were ranged from 5.5% to 49.4%. [40][41][42][43][44][45][46][47][48] Meanwhile, according to Baik et al 49 , overall postoperative complication rates of both groups had no statistical difference (10.7 vs 19.3, p=0.202), but, the major complication rate of robotic low anterior resection were significantly lower than that of laparoscopic surgery (5.4 vs 19.3, p=0.025). This study suggested that the lower major complication rate in the robotic surgery group may be associated with a faster start of the diet and shorter length of hospital stay.…”

“…[40][41][42][43][44][45][46][47][48] It is shown that the conversion rate of robotic TME had no statistical difference compared with laparoscopic TME, 40,[43][44][45][46] whereas, several studies suggested that robotic TME had a lower conversion rate than that of laparoscopic TME. 41,42,48 According to the 'Robotic vs Laparoscopic Resection for Rectal Cancer (ROLARR)' randomized controlled trial which published the primary results at JAMA in 2017, there was no significant difference in conversion rates between robotic TME and conventional laparoscopic TME (8.1% vs 12.2%, p=0.16). 50 High body mass index and male affected open conversion rate because of its technical difficulty to manipulate in the limited abdomino-pelvic cavity.…”