Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2016; 22(13): 3602-3610
Published online Apr 7, 2016. doi: 10.3748/wjg.v22.i13.3602
Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery
Francesco Feroci, Andrea Vannucchi, Paolo Pietro Bianchi, Stefano Cantafio, Alessia Garzi, Giampaolo Formisano, Marco Scatizzi
Francesco Feroci, Andrea Vannucchi, Stefano Cantafio, Alessia Garzi, Marco Scatizzi, Department of General and Oncological Surgery, Santo Stefano Hospital, 59100 Prato, Italy
Paolo Pietro Bianchi, Giampaolo Formisano, Department of General and Minimally Invasive Surgery, Misericordia Hospital, 58100 Grosseto, Italy
Author contributions: Feroci F and Vannucchi A contributed equally to this work; Feroci F and Vannucchi A designed the research, analyzed the data and drafted the manuscript; Bianchi PP and Cantafio S made an important critical revision; Garzi A and Formisano G made the acquisition of data; Scatizzi M contributed to the conception and design of the study and made the final approval; all authors have approved the final version of the article.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Santo Stefano Hospital, Prato, Italy and of the Misericordia Hospital, Grosseto, Italy.
Informed consent statement: The IRB allowed us to waive the requirement for obtaining informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to have imaging study by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Statistical analysis and dataset are available from the corresponding author at fferoci@yahoo.it.
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: Francesco Feroci, MD, Department of General and Oncological Surgery, Santo Stefano Hospital, Via Suor Niccolina 20, 59100 Prato, Italy. fferoci@yahoo.it
Telephone: +39-57-4804612
Received: December 16, 2015
Peer-review started: December 19, 2015
First decision: January 13, 2016
Revised: January 27, 2016
Accepted: February 22, 2016
Article in press: February 22, 2016
Published online: April 7, 2016
Abstract

AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.

METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.

RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.

CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.

Keywords: Robotic surgery, Laparoscopic surgery, Rectal cancer, Total mesorectal excision, Minimally invasive surgery

Core tip: The aim of this retrospective study was to compare the short- and long-term outcomes of 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent. The median surgery time was shorter for laparoscopic TME while there were no differences found in the rates of conversion to open surgery and morbidity. The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group and a shorter distal resection margin for laparoscopic patients but the three-year overall survival and disease-free survival rates were similar between groups.