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

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 11/2019

Open Access 01-11-2019 | Rectal Cancer

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

Authors: F. Polat, L. H. Willems, K. Dogan, C. Rosman

Published in: Surgical Endoscopy | Issue 11/2019

Login to get access

Abstract

Background

Colorectal 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).

Methods

Prospectively 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.

Results

206 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).

Conclusion

RACRS 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.
Literature
1.
2.
Fitzpatrick-Lewis D, Ali MU, Warren R et al (2016) Screening for colorectal cancer: a systematic review and meta-analysis. Clin Colorectal Cancer 2016 15(4):298–313CrossRef
3.
Schwenk W, Haase O, Neudecker J et al (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2:CD003145
4.
Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25(21):3061–3068CrossRef
5.
Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332CrossRef
6.
Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–774CrossRef
7.
Stevenson AR, Solomon MJ, LumleyJW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: The ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363CrossRef
8.
Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355CrossRef
9.
Baik SH, Ko YT, Kang CM et al (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22(7):1601–1608CrossRef
10.
Kim MJ, Park SC, Park JW et al (2018) Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 267(2):243–251CrossRef
11.
12.
13.
Dindo D, Demartines N, Clavien PA et al (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef
14.
15.
Lassen K, Soop M, Nygren J et al (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144(10):961–969CrossRef
16.
Soravia C, Schwieger I, Witzig JA et al (2008) Laparoscopic robotic-assisted gastrointestinal surgery: the Geneva experience. J Robot Surg 1(4):291–295CrossRef
17.
Ferrara F, Piagnerelli R, Scheiterle M et al (2016) Laparoscopy versus robotic surgery for colorectal cancer: a single-center initial experience. Surg Innov 23(4):374–380CrossRef
18.
Rawlings AL, Woodland JH, Vegunta RK et al (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21(10):1701–1708CrossRef
19.
Luca F, Ghezzi TL, Valvo M et al (2011) Surgical and pathological outcomes after right hemicolectomy: case-matched study comparing robotic and open surgery. Int J Med Robot 7(3):298–303PubMed
20.
Kang J, Park YA, Baik SH et al (2016) A comparison of open, laparoscopic, and robotic surgery in the treatment of right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 26(6):497–502CrossRef
21.
Parisi A, Scrucca L, Desiderio J et al (2017) Robotic right hemicolectomy: analysis of 108 consecutive procedures and multidimensional assessment of the learning curve. Surg Oncol 26(1):28–36CrossRef
22.
Kwak JM, Kim SH, Kim J et al (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 54(2):151–156CrossRef
23.
Baik SH, Kwon HY, Kim JS et al (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16(6):1480–1487CrossRef
24.
Park JS, Choi GS, Lim KH et al (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17(12):3195–3202CrossRef
25.
Bianchi PP, Ceriani C, Locatelli A et al (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24(11):2888–2894CrossRef
26.
Patriti A, Ceccarelli G, Bartoli A et al (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13(2):176–183PubMedPubMedCentral
27.
Baek SJ, Kim CH, Cho MS et al (2015) Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy. Surg Endosc 29(6):1419–1424CrossRef
28.
Park EJ, Cho MS, Baek SJ et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261(1):129–137CrossRef
29.
Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235(4):449–457CrossRef
30.
Jagoditsch M, Lisborg PH, Jatzko GR et al (2000) Long-term prognosis for colon cancer related to consistent radical surgery multivariate analysis of clinical, surgical, and pathologic variables. World J Surg 24:1264–1270CrossRef
31.
Ozben V, Cengiz TB, Atasoy D et al (2016) Is da Vinci Xi better than da Vinci Si in robotic rectal cancer surgery? Comparison of the 2 generations of da Vinci Systems. Surg Laparosc Endosc Percutan Tech 26(5):417–423CrossRef
32.
Morelli L, Di Franco G, Guadagni S et al (2018) Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc 32(2):589–600CrossRef
Metadata
Title
The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study
Authors
F. Polat
L. H. Willems
K. Dogan
C. Rosman
Publication date
01-11-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-06653-2

Other articles of this Issue 11/2019

Surgical Endoscopy 11/2019 Go to the issue

Review Article

Comparison of clinical outcomes of laparoscopic versus open surgery for recurrent hepatocellular carcinoma: a meta-analysis

OriginalPaper

Liver resection for extra-pancreatic biliary cancer: what is the role of laparoscopic approach?

Dynamic Manuscript

Pure laparoscopic right posterior sectionectomy using the caudate lobe-first approach

OriginalPaper

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

2018 SAGES Oral

S128: Active post discharge surveillance program as a part of Enhanced Recovery After Surgery protocol decreases emergency department visits and readmissions in colorectal patients

OriginalPaper

Spotting malignancies from gastric endoscopic images using deep learning