Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2020; 12(4): 424-434
Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.424
Robotic- vs laparoscopic-assisted proctectomy for locally advanced rectal cancer based on propensity score matching: Short-term outcomes at a colorectal center in China
Shan-Ping Ye, Wei-Quan Zhu, Dong-Ning Liu, Xiong Lei, Qun-Guang Jiang, Hui-Min Hu, Bo Tang, Peng-Hui He, Geng-Mei Gao, He-Chun Tang, Jun Shi, Tai-Yuan Li
Shan-Ping Ye, Wei-Quan Zhu, Dong-Ning Liu, Xiong Lei, Qun-Guang Jiang, Bo Tang, Peng-Hui He, Geng-Mei Gao, He-Chun Tang, Jun Shi, Tai-Yuan Li, Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Shan-Ping Ye, Wei-Quan Zhu, Hui-Min Hu, Bo Tang, Geng-Mei Gao, He-Chun Tang, Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Ye SP and Li TY designed the research; Ye SP, Zhu WQ, He PH, Gao GM, Tang HC, and Hu HM collected data and conducted the analysis of pooled data; Ye SP, Lei X and Liu DN helped to draft the manuscript; Ye SP, Jiang QG and Tang B wrote the manuscript; Ye SP and Shi J proofread and revised the manuscript; all authors have approved the version to be published.
Supported by the Infrastructure Supporting Project of Jiangxi Scientific Research Institute, No. 20142BBA13039.
Institutional review board statement: The current study was approved by the institutional review board of our hospital (2016-050) and complies with the Helsinki Declaration.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: Access to the database can be obtained from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Tai-Yuan Li, MD, PhD, Chief Doctor, Director, Professor, Department of General Surgery, First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. litaiyuanyfy@sina.com
Received: December 11, 2019
Peer-review started: December 11, 2019
First decision: December 26, 2019
Revised: December 28, 2019
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 15, 2020
ARTICLE HIGHLIGHTS
Research background

Rectal cancer is a major cause of cancer-related deaths, particularly in advanced stage cases. More and more studies about minimally invasive surgery for rectal cancer are reported. However, few of them have focused only on locally advanced rectal cancer (LARC), and most of them have relatively small sample sizes. Indeed, true benefits of minimally invasive surgery (robot or laparoscopy) for LARC are still controversial.

Research motivation

We hope to provide clinical guidance for minimally invasive (robotic-assisted or laparoscopic-assisted) surgery of LARC.

Research objectives

To investigate the optimal mini-invasive proctectomy methods (robotic-assisted or laparoscopic-assisted) for advanced rectal cancer.

Research methods

We retrospectively collected the clinicopathological data of patients with LARC who underwent minimally invasive surgery from January 2015 to October 2019. The propensity-score matching analysis was used to reduce patient selection bias of the current retrospective cohort study. The clinical baseline data, intraoperative and postoperative outcomes and postoperative complications were compared between the two groups.

Research results

In the current study, 293 patients were enrolled in each group. The robotic-assisted proctectomy (RAP) was associated with less intraoperative blood loss (P = 0.000), lower volume of pelvic cavity drainage (P = 0.000), less time to remove the pelvic drainage tube and urinary catheter (P = 0.000 and 0.000), longer distal resection margin (P = 0.000) and lower rates of conversion (P = 0.037) as compared with the laparoscopic-assisted proctectomy. However, the time to recover bowel function, the harvested lymph nodes, the postoperative length of hospital stay, the rate of unplanned readmission within 30 days postoperatively, complications and its subgroups were similar between the two groups, all P > 0.05.

Research conclusions

The current retrospective cohort study revealed that RAP is a safe and feasible surgery. Compared with laparoscopic-assisted proctectomy, RAP has many advantages for LARC.

Research perspectives

The conclusions of the present retrospective cohort study may help surgeon to develop clinical guidelines with regard to mini-invasive surgery methods in the field of LARC more perfectly. We believe that research on robotic surgery is a hot topic in the field of colorectal cancer in the future. And, high quality multicenter randomized controlled clinical trial is the optimal method for future research.