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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 546-556
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.546
Dealing with robot-assisted surgery for rectal cancer: Current status and perspectives
Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany
Roberto Biffi, Fabrizio Luca, Paolo Pietro Bianchi, Sabina Cenciarelli, Wanda Petz, Igor Monsellato, Manuela Valvo, Maria Laura Cossu, Tiago Leal Ghezzi, Kassem Shmaissany, Department of Gastrointestinal Surgery, European Institute of Oncology, 20141 Milan, Italy
Author contributions: Biffi R, Luca F, Bianchi PP, Cenciarelli S, Petz W, Monsellato I and Valvo M substantially contributed to conception and design of the study, acquisition of data, or analysis and interpretation of data; Biffi R, Luca F, Bianchi PP, Cossu ML, Ghezzi TL and Shmaissany K contributed to drafting the article or making critical revision related to important intellectual content of the manuscript; Biffi R and Shmaissany K final approved the version of the article to be published.
Conflict-of-interest statement: Authors declare they have no conflicting interests to disclose, related to the work they have submitted for consideration of publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberto Biffi, MD, FSPS, Medical Director, Department of Gastrointestinal Surgery, European Institute of Oncology, Via G.Ripamonti 435, 20141 Milan, Italy. roberto.biffi@ieo.it
Telephone: +39-2-57489710 Fax: +39-2-94379215
Received: June 28, 2015
Peer-review started: July 1, 2015
First decision: July 20, 2015
Revised: September 8, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 14, 2016
Abstract

The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition three-dimensional vision, it translates the surgeon’s hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors’ centre.

Keywords: Rectal cancer, Robotic total mesorectal excision, Robotic surgery, Robotic resection, Circumferential resection margin, Lymph node yield, Distal resection margin positivity

Core tip: The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors’ centre. A detailed review of this topic is provided, including the most recent findings of prospective studies. Future perspectives are also analyzed.