Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2023 | Rectal Cancer | Research

Comparison of robotic-assisted and laparoscopic-assisted natural orifice specimen extraction surgery in short-terms outcomes of middle rectal cancer

Authors: Shan-ping Ye, Hong-xin Yu, Dong-ning Liu, Wei-jie Lu, Can Wu, Hao-cheng Xu, Tai-yuan Li

Published in: World Journal of Surgical Oncology | Issue 1/2023

Abstract

Background

Surgery is becoming less invasive as technology advances. Natural orifice specimen extraction surgery (NOSES) ushered in a new era of minimally invasive techniques. At the same time, NOSES is gaining popularity in the world. With their distinct advantages, surgical robots have advanced the development of NOSES. The aim of current study was to compare the short-term outcomes between robotic-assisted NOSES and laparoscopic-assisted NOSES for the treatment of middle rectal cancer.

Methods

Patients with middle rectal cancer who underwent robotic-assisted or laparoscopic-assisted NOSES at the First Affiliated Hospital of Nanchang University between January 2020 and June 2022 had their clinicopathological data collected retrospectively. 46 patients were enrolled in the study: 23 in the robotic group and 23 in the laparoscopic group. Short-term outcomes and postoperative anal function in the two groups were compared.

Results

There was no significant difference in the clinicopathological data between the two groups. The robotic group had less intraoperative blood loss (p = 0.04), less postoperative abdominal drainage (p = 0.02), lower postoperative white blood cell counts (p = 0.024) and C-reactive protein levels (p = 0.017), and shorter catheter removal time when compared to the laparoscopic group (p = 0.003). Furthermore, there were no significant difference in mean operative time (159 ± 31 min vs 172 ± 41 min) between the robotic and laparoscopic groups (p = 0.235), but time to naked the rectum (86.4 ± 20.9 min vs. 103.8 ± 31.5 min p = 0.033) and time of digestive tract reconstruction (15.6 ± 3.88 min vs. 22.1 ± 2.81 min p < 0.01) in the robotic group were significantly shorter than laparoscopic group. The robotic group had lower postoperative Wexner scores than the laparoscopic group.

Conclusions

This research reveals that combining a robotic surgical system and NOSES results in superior outcomes, with short-term outcomes preferable to laparoscopic-assisted NOSES.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660. (Epub 2021 Feb 4 PMID: 33538338).CrossRefPubMed

Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394(10207):1467–80. https://doi.org/10.1016/S0140-6736(19)32319-0. (PMID: 31631858).CrossRefPubMed

Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H; Clinical outcomes of surgical therapy study group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–62; discussion 662–4. https://doi.org/10.1097/SLA.0b013e318155a762. PMID: 17893502.

Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM; UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8. https://doi.org/10.1200/JCO.2006.09.7758. PMID: 17634484.

Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM. Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002;16(10):1420–5. https://doi.org/10.1007/s00464-002-8837-3. (Epub 2002 Jun 27 PMID: 12085142).CrossRefPubMed

Ihedioha U, Mackay G, Leung E, Molloy RG, O’Dwyer PJ. Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc. 2008;22(3):689–92. https://doi.org/10.1007/s00464-007-9462-y. (PMID: 17623241).CrossRefPubMed

Safiejko K, Tarkowski R, Koselak M, Juchimiuk M, Tarasik A, Pruc M, Smereka J, Szarpak L. Robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection: a systematic review and meta-analysis of 19,731 patients. Cancers (Basel). 2021;14(1):180. https://doi.org/10.3390/cancers14010180. PMID: 35008344; PMCID: PMC8750860.

Wee IJY, Kuo LJ, Ngu JC. Urological and sexual function after robotic and laparoscopic surgery for rectal cancer: a systematic review, meta-analysis and meta-regression. Int J Med Robot. 2021;17(1):1–8. https://doi.org/10.1002/rcs.2164. (Epub 2020 Sep 17 PMID: 32945090).CrossRefPubMed

Crippa J, Grass F, Dozois EJ, Mathis KL, Merchea A, Colibaseanu DT, Kelley SR, Larson DW. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort. Ann Surg. 2021;274(6):e1218–22. https://doi.org/10.1097/SLA.0000000000003805. (PMID: 32068552).CrossRefPubMed

10.

Thakkar S, Pancholi A, Carleton N. Natural orifice specimen extraction for colorectal cancer removal: the best of both worlds. Gastrointest Endosc. 2021;94(3):651–2. https://doi.org/10.1016/j.gie.2021.05.028. (Epub 2021 Jul 16 PMID: 34275606).CrossRefPubMed

11.

Park JS, Choi GS, Kim HJ, Park SY, Jun SH. Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg. 2011;98(5):710–5. https://doi.org/10.1002/bjs.7419. (Epub 2011 Feb 8 PMID: 21305535).CrossRefPubMed

12.

Tang Q, Zhu Y, Xiong H, Sheng X, Hu Z, Hu H, Huang R, Zhang Q, Yuan Z, Xie L, Gao Z, Wang Y, Wang G, Wang X. Natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection in the treatment of colorectal cancer: a propensity-score matching study. Cancer Manag Res. 2021;13:2247–57. https://doi.org/10.2147/CMAR.S291085. (PMID:33727861;PMCID:PMC7955728).CrossRefPubMedPubMedCentral

13.

Zhu Y, Xiong H, Chen Y, Liu Z, Jiang Z, Huang R, Gao F, Zhang Q, Wang M, Jin Y, Qiao T, Ma T, Hu H, Wang X, Tang Q, Wang G. Comparison of natural orifice specimen extraction surgery and conventional laparoscopic-assisted resection in the treatment effects of low rectal cancer. Sci Rep. 2021;11(1):9338. https://doi.org/10.1038/s41598-021-88790-8. (PMID:33927293;PMCID:PMC8085046).CrossRefPubMedPubMedCentral

14.

Zhou ZQ, Wang K, Du T, et al. Transrectal natural orifice specimen extraction (nose) with oncological safety: a prospective and randomized trial. J Surg Res. 2020;254:16–22. https://doi.org/10.1016/j.jss.2020.03.064.CrossRefPubMed

15.

Xu SZ, Ding ZJ, Zhang SF, et al. Clinical outcomes of laparoscopic-assisted natural orifice specimen extraction colectomy using a Cai tube for left-sided colon cancer: a prospective randomized trial. Surg Endosc. 2023;37(1):749–58. https://doi.org/10.1007/s00464-022-09435-z.CrossRefPubMed

16.

Ye SP, Zhu WQ, Liu DN, Lei X, Jiang QG, Hu HM, Tang B, He PH, Gao GM, Tang HC, Shi J, Li TY. Robotic- vs laparoscopic-assisted proctectomy for locally advanced rectal cancer based on propensity score matching: short-term outcomes at a colorectal center in China. World J Gastrointest Oncol. 2020;12(4):424–34. https://doi.org/10.4251/wjgo.v12.i4.424.PMID:32368320;PMCID:PMC7191331.CrossRefPubMedPubMedCentral

17.

Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M. Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc. 2002;16(12):1691–6. https://doi.org/10.1007/s00464-002-9043-z. (Epub 2002 Jul 29 PMID: 12140631).CrossRefPubMed

18.

Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F, Gullà N, Noya G, Boselli C. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis. 2012;14(4):e134–56. https://doi.org/10.1111/j.1463-1318.2011.02907.x. (PMID: 22151033).CrossRefPubMed

19.

Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20(10):1521–5. https://doi.org/10.1007/s00464-005-0855-5. (Epub 2006 Aug 1 PMID: 16897284).CrossRefPubMed

20.

D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum. 2004;47(12):2162–8. https://doi.org/10.1007/s10350-004-0711-z. (PMID: 15657669).CrossRefPubMed

21.

Feng Q, Yuan W, Li T, Tang B, Jia B, Zhou Y, Zhang W, Zhao R, Zhang C, Cheng L, Zhang X, Liang F, He G, Wei Y, Xu J; REAL Study Group. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(11):991–1004. https://doi.org/10.1016/S2468-1253(22)00248-5. Epub 2022 Sep 8. PMID: 36087608.

22.

DeNoto G, Rubach E, Ravikumar TS. A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A. 2006;16(6):551–6. https://doi.org/10.1089/lap.2006.16.551. (PMID: 17243868).CrossRefPubMed

23.

Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339–46. https://doi.org/10.1002/bjs.9354. (Epub 2013 Dec 5 PMID: 24311257).CrossRefPubMed

24.

Hibino S, Kawazoe T, Kasahara H, Itoh S, Ishimoto T, Sakata-Yanagimoto M, Taniguchi K. Inflammation-induced tumorigenesis and metastasis. Int J Mol Sci. 2021;22(11):5421. https://doi.org/10.3390/ijms22115421.CrossRefPubMedPubMedCentral

25.

Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7. https://doi.org/10.1038/nature01322. (PMID:12490959;PMCID:PMC2803035).CrossRefPubMedPubMedCentral

26.

Leroy J, Costantino F, Cahill RA, D’Agostino J, Morales A, Mutter D, Marescaux J. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg. 2011;98(9):1327–34. https://doi.org/10.1002/bjs.7517. (Epub 2011 May 10 PMID: 21560119).CrossRefPubMed

27.

Ngu J, Wong AS. Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns. ANZ J Surg. 2016;86(4):299–302. https://doi.org/10.1111/ans.13383. (Epub 2015 Nov 24 PMID: 26603221).CrossRefPubMed

28.

Guan X, Liu Z, Longo A, Cai JC, Tzu-Liang Chen W, Chen LC, Chun HK, Manuel da Costa Pereira J, Efetov S, Escalante R, He QS, Hu JH, Kayaalp C, Kim SH, Khan JS, Kuo LJ, Nishimura A, Nogueira F, Okuda J, Saklani A, Shafik AA, Shen MY, Son JT, Song JM, Sun DH, Uehara K, Wang GY, Wei Y, Xiong ZG, Yao HL, Yu G, Yu SJ, Zhou HT, Lee SH, Tsarkov PV, Fu CG, Wang XS; International Alliance of NOSES. International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer. Gastroenterol Rep (Oxf). 2019;7(1):24–31. https://doi.org/10.1093/gastro/goy055. Epub 2019 Jan 23. PMID: 30792863; PMCID: PMC6375350.

29.

Zhang J, Li W, Li Y, Amin B, Zhang N, Sun Z, Zhu B. Short- and long-term outcomes as well as anal function of transanal natural orifice specimen extraction surgery versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection: a retrospective study with over 5-year follow-up. Wideochir Inne Tech Maloinwazyjne. 2022;17(2):344–351. https://doi.org/10.5114/wiitm.2022.113567. Epub 2022 Feb 18. PMID: 35707343; PMCID: PMC9186073.

30.

Grass JK, Chen CC, Melling N, Lingala B, Kemper M, Scognamiglio P, Persiani R, Tirelli F, Caricato M, Capolupo GT, Izbicki JR, Perez DR. Robotic rectal resection preserves anorectal function: systematic review and meta-analysis. Int J Med Robot. 2021;17(6):e2329. https://doi.org/10.1002/rcs.2329. Epub 2021 Sep 9. PMID: 34463416.

31.

Broholm M, Pommergaard HC, Gögenür I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis. 2015;17(5):375–81. https://doi.org/10.1111/codi.12872. (PMID: 25515638).CrossRefPubMed

32.

Luca F, Cenciarelli S, Valvo M, Pozzi S, Faso FL, Ravizza D, Zampino G, Sonzogni A, Biffi R. Full robotic left colon and rectal cancer resection: technique and early outcome. Ann Surg Oncol. 2009;16(5):1274–8. https://doi.org/10.1245/s10434-009-0366-z. (Epub 2009 Feb 26 PMID: 19242762).CrossRefPubMed

Title: Comparison of robotic-assisted and laparoscopic-assisted natural orifice specimen extraction surgery in short-terms outcomes of middle rectal cancer
Authors: Shan-ping Ye
Hong-xin Yu
Dong-ning Liu
Wei-jie Lu
Can Wu
Hao-cheng Xu
Tai-yuan Li
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Rectal Cancer
Rectal Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2023
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-023-03083-w

2024 ASCO Annual Meeting

Springer Medicine

Comparison of robotic-assisted and laparoscopic-assisted natural orifice specimen extraction surgery in short-terms outcomes of middle rectal cancer

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Lymphovascular invasion is a significant risk factor for non-sentinel nodal metastasis in breast cancer patients with sentinel lymph node (SLN)-positive breast cancer: a cross-sectional study

Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

The diagnostic accuracy of 332 incisional biopsies in patients with malignant tumors in the musculoskeletal system

Synchronous pulmonary MALT lymphoma and squamous cell lung cancer: a case report

Predictive factors and repetition numbers for intraoperative additional resection of initially involved soft tissue resection margins in oral squamous cell carcinoma: a retrospective study

The advanced lung cancer inflammation index is a prognostic factor for gastrointestinal cancer patients undergoing surgery: a systematic review and meta-analysis