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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2012

01-07-2012 | Healthcare Policy and Outcomes

Robotic versus Laparoscopic Proctectomy for Rectal Cancer: A Meta-analysis

Authors: Sameer Memon, FRACS, Alexander G. Heriot, MD, MBA, FRACS, FRCS, Declan G. Murphy, FRCS Urol, Mathias Bressel, MSc, A. Craig Lynch, MMedSci, FRACS, FCSSANZ, FASCRS (Int)

Published in: Annals of Surgical Oncology | Issue 7/2012

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Abstract

Background

Robot-assisted laparoscopic surgery is being performed more frequently for the minimally invasive management of rectal cancer. The objective of this meta-analysis was to compare the clinical and oncologic safety and efficacy of robot-assisted versus conventional laparoscopic surgery.

Methods

A search of the Medline and Embase databases was performed for studies that compared clinical or oncologic outcomes of conventional laparoscopic proctectomy with robot-assisted laparoscopic proctectomy for rectal cancer. The methodological quality of the selected studies was critically assessed to identify studies suitable for inclusion. Meta-analysis was performed by a random effects model and analyzed by Review Manager. Clinical outcomes evaluated were conversion rates, operation times, length of hospital stay, and complications. Oncologic outcomes evaluated were circumferential margin status, number of lymph nodes collected, and distal resection margin lengths.

Results

Eight comparative studies were assessed for quality, and seven studies were included in the meta-analysis. Two studies were matched case-control studies, and five were unmatched. A total of 353 robot-assisted laparoscopic surgery proctectomy cases and 401 conventional laparoscopic surgery proctectomy cases were analyzed. Robotic surgery was associated with a significantly lower conversion rate (P = 0.03; 95% confidence interval 1–12). There was no difference in complications, circumferential margin involvement, distal resection margin, lymph node yield, or hospital stay (P = NS).

Conclusions

Robot-assisted surgery decreased the conversion rate compared to conventional laparoscopic surgery. Other clinical outcomes and oncologic outcomes were equivalent. The benefits of robotic rectal cancer surgery may differ between population groups.
Literature
1.
Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.PubMedCrossRef
2.
Kennedy GD, Heise C, Rajamanickam V, Harms B, Foley EF. Laparoscopy decreases postoperative complication rates after abdominal colectomy: results from the national surgical quality improvement program. Ann Surg. 2009;249:596–601.PubMedCrossRef
3.
Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–9.PubMedCrossRef
4.
Schwab KE, Dowson HM, Van Dellen J, Marks CG, Rockall TA. The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI. Colorectal Dis. 2009;11:318–22.PubMedCrossRef
5.
Delaney CP, Lynch AC, Senagore AJ, Fazio VW. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum. 2003;46:1633–9.PubMedCrossRef
6.
Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ. Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis. 2010;12:1084–93.PubMedCrossRef
7.
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the medical research council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97:1638–45.PubMedCrossRef
8.
Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann Surg. 2007;246:655–62.PubMedCrossRef
9.
Jayne D, Pigassi A, Tsang C, et al. ROLARR: robotic versus laparoscopic resection for rectal cancer. Colorectal Dis. 2010;12:28–9.CrossRef
10.
11.
Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? evidence-based medicine working group. JAMA. 1993;270:2598–601.PubMedCrossRef
12.
Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? evidence-based medicine working group. JAMA. 1994;271:59–63.PubMedCrossRef
13.
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.0.1. Chichester: Wiley; 2008.CrossRef
14.
Popescu I, Vasilescu C, Tomulescu V, Vasile S, Sgarbura O. The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience. Acta Chir Iugosl. 2010;57:29–35.PubMedCrossRef
15.
Leong QM, Son DN, Cho JS, et al. Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc. 2011;25:2987–92.PubMedCrossRef
16.
Baik SH, Kwon HY, Kim JS, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16:1480–7.PubMedCrossRef
17.
Bianchi PP, Ceriani C, Locatelli A, et al. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc. 2010;24:2888–94.PubMedCrossRef
18.
Kim NK, Kang J. Optimal total mesorectal excision for rectal cancer: the role of robotic surgery from an expert’s view. J Korean Soc Coloproctol. 2010;26:377–87.PubMedCrossRef
19.
Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum. 2011;54:151–6.PubMedCrossRef
20.
Park JS, Choi GS, Lim KH, Jang YS, Jun SH. S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc. 2011;25:240–8.PubMedCrossRef
21.
Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L. Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS. 2009;13:176–83.PubMed
22.
Park JS, Choi GS, Lim KH, Jang YS, Jun SH. Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol. 2010;17:3195–202.PubMedCrossRef
23.
Hong Y, Baik Y, Hur H, Min B, Lee K, Kim N. Comparison of short-term outcomes after hybrid vs totally robotic total mesorectal excision. Dis Colon Rectum. 2010;53:698.
24.
Sartori CA, Dal Pozzo A, Franzato B, Balduino M, Sartori A, Baiocchi GL (2011) Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients. Surg Endosc. 25:508–14.PubMedCrossRef
25.
Peeters KC, Marijnen CA, Nagtegaal ID, et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246:693–701.PubMedCrossRef
26.
Quirke P, Steele R, Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8.PubMedCrossRef
27.
Read TE, Myerson RJ, Fleshman JW, et al. Surgeon specialty is associated with outcome in rectal cancer treatment. Dis Colon Rectum. 2002;45:904–14.PubMedCrossRef
Metadata
Title
Robotic versus Laparoscopic Proctectomy for Rectal Cancer: A Meta-analysis
Authors
Sameer Memon, FRACS
Alexander G. Heriot, MD, MBA, FRACS, FRCS
Declan G. Murphy, FRCS Urol
Mathias Bressel, MSc
A. Craig Lynch, MMedSci, FRACS, FCSSANZ, FASCRS (Int)
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2270-1

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