Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2024

05-02-2024 | Rectal Cancer | Colorectal Cancer

Is Robotic Surgery Beneficial for Rectal Cancer Patients with Unfavorable Characteristic After Neoadjuvant Chemoradiotherapy?

Authors: Jung Kyong Shin, MD, Hee Cheol Kim, MD, PhD, Woo Yong Lee, MD, PhD, Seong Hyeon Yun, MD, PhD, Yong Beom Cho, MD, PhD, Jung Wook Huh, MD, PhD, Yoon Ah Park, MD

Published in: Annals of Surgical Oncology | Issue 5/2024

Login to get access

Abstract

Background

The objective of this study was to compare long-term oncologic outcomes of robot and laparoscopic surgeries for patients with advanced rectal cancer who underwent neoadjuvant chemoradiotherapy (nCRT) followed by radical resection.

Methods

This study analyzed 3240 rectal cancer patients who underwent radical surgery from 2008 to 2019. Among them, 1204 patients who received nCRT (robotic, n = 316; laparoscopic, n = 888) were analyzed. The oncological outcome according to the number of unfavorable factors (male, body mass index ≥ 25, receiving CCRT) present in patients also was analyzed. We used 1:1 propensity score matching (PSM) to adjust for potential baseline confounders between groups.

Results

After PSM, two groups showed similar demographics and pathological results. After PSM analysis, the robotic group showed higher 5-year disease-free survival (DFS) and local recurrence-free survival rates than the laparoscopic group, whereas 5-year overall survival and distant recurrence-free survival rates were similar between the two groups. In addition, by comparing survival rates for each yp stage, it was found 5-year DFS and local recurrence-free survival of the robotic group in yp stage III were significantly higher than those of the laparoscopic group. Five-year DFS was conducted according to the number of unfavorable factors (male, body mass index ≥ 25 kg/m2, and undergoing nCRT) as a subgroup analysis. In patients with all three unfavorable factors, the robotic group showed significantly higher DFS than the laparoscopic group.

Conclusions

Robotic approach for rectal cancer after nCRT, especially for patients with yp stage III and unfavorable factors, have the advantage of improving oncologic outcomes even for surgeons specializing in colorectal cancer.
Appendix
Available only for authorised users
Literature
1.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.CrossRefPubMed
2.
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82.CrossRefPubMed
3.
Rickles AS, Dietz DW, Chang GJ, et al. High rate of positive circumferential resection margins following rectal cancer surgery: a call to action. Ann Surg. 2015;262(6):891–8.CrossRefPubMed
4.
van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.CrossRefPubMed
5.
Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11(7):637–45.CrossRefPubMed
6.
Stevenson AR, Solomon MJ, Lumley JW, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA. 2015;314(13):1356–63.CrossRefPubMed
7.
Stevenson ARL, Solomon MJ, Brown CSB, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg. 2019;269(4):596–602.CrossRefPubMed
8.
Wexner SD, Bergamaschi R, Lacy A, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc. 2009;23(2):438–43.CrossRefPubMed
9.
Kim J, Baek SJ, Kang DW, et al. Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum. 2017;60(3):266–73.CrossRefPubMed
10.
Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc. 2017;31(7):2798–807.CrossRefPubMed
11.
Zhang X, Wei Z, Bie M, Peng X, Chen C. Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc. 2016;30(12):5601–14.CrossRefPubMed
12.
Lim DR, Bae SU, Hur H, et al. Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc. 2017;31(4):1728–37.CrossRefPubMed
13.
Feroci F, Vannucchi A, Bianchi PP, et al. Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery. World J Gastroenterol. 2016;22(13):3602–10.CrossRefPubMedPubMedCentral
14.
Park SY, Lee SM, Park JS, Kim HJ, Choi GS. Robot surgery shows similar long-term oncologic outcomes as laparoscopic surgery for mid/lower rectal cancer but is beneficial to ypT3/4 after preoperative chemoradiation. Dis Colon Rectum. 2021;64(7):812–21.CrossRefPubMed
15.
Rouanet P, Bertrand MM, Jarlier M, et al. Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol. 2018;25(12):3572–9.CrossRefPubMed
Metadata
Title
Is Robotic Surgery Beneficial for Rectal Cancer Patients with Unfavorable Characteristic After Neoadjuvant Chemoradiotherapy?
Authors
Jung Kyong Shin, MD
Hee Cheol Kim, MD, PhD
Woo Yong Lee, MD, PhD
Seong Hyeon Yun, MD, PhD
Yong Beom Cho, MD, PhD
Jung Wook Huh, MD, PhD
Yoon Ah Park, MD
Publication date
05-02-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-14976-9

Other articles of this Issue 5/2024

Annals of Surgical Oncology 5/2024 Go to the issue

Gastrointestinal Oncology

Long-Term Outcome of Proximal Gastrectomy for Upper-Third Advanced Gastric and Siewert Type II Esophagogastric Junction Cancer Compared With Total Gastrectomy: A Propensity Score-Matched Analysis

ASO Author Reflections

ASO Author Reflections: Laparoscopic Surgery for Intrahepatic Cholangiocarcinoma—Opportunities and Challenges

Pancreatic Tumors

Neoadjuvant Chemotherapy is Associated with Increased Risk of Postoperative DVT After Distal Pancreatectomy for Pancreatic Adenocarcinoma: a NSQIP Analysis

Reconstructive Oncology

Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications

Translational Research

COL8A1 Regulates Esophageal Squamous Carcinoma Proliferation and Invasion Through PI3K/AKT Pathway

ASO Author Reflections

ASO Author Reflections: Association of COVID-19 Pandemic with Colorectal Cancer Screening: Impact of Race/Ethnicity and Social Vulnerability