Robotic surgery for rectal cancer: Current immediate clinical and oncological outcomes

Table 1 Use of robotics in rectal cancer surgery (case series, comparative, and randomized studies)

Ref.	Year	Country	Study design	Surgical technique	Number of patients	Neoadjuvant treatment	TME operation
							Anterior resection	Intersphincteric resection	Abdomino- perineal resection
Hellan et al[28]	2007	United States	Case series	Hybrid	39	33	22	11	6
Choi et al[29]	2009	Korea	Case series	Hybrid	13	NA	13
Choi et al[19]	2009	Korea	Case series	Totally robotic	50	NA	40	8	2
Ng et al[30]	2009	Singapore	Case series	Hybrid	8	NA	8
deSouza et al[31]	2010	United States	Case series	Hybrid	44	31	30	6	8
Pigazzi et al[32]	2010	United States, Italy, Korea	Case series	Hybrid	143	93	80	32	31
Baek et al[33]	2010	United States	Case series	Hybrid	64	55	34	18	12
Zimmern et al[34]	2010	United States	Case series	Hybrid	58	23	47		11
Kang et al[20]	2011	Korea	Case series	Totally robotic	269	72	265		4
				Hybrid	120		118		2
Koh et al[35]	2011	Singapore	Case series	Hybrid	19	2	18		1
Leong et al[21]	2011	Korea	Case series	Totally robotic	29	11		29
Marecik et al[36]	2011	United States	Case series	Hybrid	5	4			5
Alimoglu et al[24]	2012	Turkey	Case series	Totally robotic	7	4			7
Kang et al[37]	2012	United States	Case series	Hybrid	6	5			6
Karahasanoglu et al[38]	2012	Turkey	Case series	Hybrid	30	7	27		3
Park et al[39]	2012	United States	Case series	Hybrid	30	20	5	19	6
Du et al[40]	2013	China	Case series	Hybrid	22	NA	22
Pigazzi et al[41]	2006	United States	Comparative	Hybrid	6	2	6
Baik et al[18]	2008	Korea	Randomized	Hybrid	18	0	18
Patriti et al[42]	2009	Italy	Comparative	Hybrid	29	7	29
Baik et al[43]	2009	Korea	Comparative	Hybrid	56	5	56
Bianchi et al[22]	2010	Italy	Comparative	Totally robotic	25	13	18		7
Popescu et al[44]	2010	Romania	Comparative	Hybrid	38	NA	30	0	8
Kim et al[23]	2010	Korea	Comparative	Totally robotic	100	14	100
Park et al[45]	2010	Korea	Comparative	Hybrid	41	14	29	12
Park et al[46]	2011	Korea	Comparative	Hybrid	52	12	52
Baek et al[47]	2011	United States	Comparative	Hybrid	41	33	33	2	6
Kwak et al[48]	2011	Korea	Comparative	Hybrid	59	8	54	5
Kim et al[25]	2012	Korea	Comparative	Totally robotic	100	34	55	45
Park et al[49]	2013	Korea	Comparative	Hybrid	40	32		40
Kang et al[26]	2013	Korea	Comparative	Totally robotic	165	39	165
D’Annibale et al[27]	2013	Italy	Comparative	Totally robotic	50	34	50

TME: Total mesorectal excision; NA: Not available.

Table 2 Use of robotics in rectal cancer surgery - clinical outcomes

Ref.	Type of procedure	Number of patients	Mean operating time (min)	Estimated blood loss (mL)	Length of stay (d)	Conversion rate (%)	Overall complication rate	Anastomotic complications
Hellan et al[28]	RTME	39	285 (180-540)	200 (25-6000)	4	2.6	12.8%	12.1%
Choi et al[29]	RTME	13	260 (210-390)	NA	7	0	23%	7.7%
Choi et al[19]	RTME	50	304 (190-405)	NA	9.2 (5-24)	0	18%	8.3%
Ng et al[30]	RTME	8	192 (145-2500	NA	5 (4-30)	0	0%	0%
deSouza et al[31]	RTME	44	347 (155-510)	250 (50-1000)	5 (3-36)	4.5	4.5%	4.5%
Pigazzi et al[32]	RTME	143	297 (90-660)	283 (0-6000)	8.3 (2-33)	4.9	41.3%	10.5%
Baek et al[33]	RTME	64	270 (150-540)	200 (20-6000)	5 (2-33)	9.4	35.9%	7.7%
Zimmern et al[34]	RTME	58	350	250	6	1.7	24.1%	3.4%
Kang et al[20]	RTME	389	305.4 ± 111.5/ 339.3 ± 127.41	NA	8.7 ± 3.0/ 17.6 ± 13.31	0/11	19%	7%
Koh et al[35]	RTME	19	316 (232-444)	NA	6.4 (3-21)	0	14.3%	0%
Leong et al[21]	RTME	29	325 (235-435)	50 (50-1000)	9 (5-15)	0	10.3%	31%
Marecik et al[36]	RTME	5	343 (270-442)	230 (100-400)	5.8 (5-7)	0	20%	0%2
Alimoglu et al[24]	RTME	7	NA	NA	8.1 (5-10)	0	28.6%	0%2
Kang et al[37]	RTME	6	335 (267-452)	250 (150-400)	5 (4-7)	0	50%	0%2
Karahasanoglu et al[38]	RTME	22	270 (175-480)	50 (20-100)	4 (4-20)	0	13.3%	3.3%
	RPME	8
Park et al[39]	RTME	30	369 (306-410)	100 (75-200)	4 (3-6)	0	36.6%	4.2%
Du et al[40]	RTME	22	220 (152-286)	33 (10-70)	7.8 (7-13)	0	4.5%	0%
Pigazzi et al[41]	RTME	6	264 (192-318)	104	4.5 (3-11)	0	16.6%	0%
	LTME	6	258 (198-312)	150	3.6 (3-6)	0	16.6%	0%
Baik et al[18]	RTME	18	203 (149-315)	NA	7 (5-10)4	0	22.2%	0%
	LTME	18	196 (114-297)	NA	9 (6-12)4	11.1	5.5%	0%
Patriti et al[42]	RTME	29	202 ± 12	137 ± 156	11.9 (6-29)	04	30.6%	6.8%
	LTME	37	208 ± 7	127 ± 169	9.6 (5-37)	18.94	18.9%	2.7%
Baik et al[43]	RTME	56	178 (120-315)	NA	5 (5-10)4	04	5.4%4	1.7%
	LTME	57	179 (100-360)	NA	6 (4-16)4	10.54	19.3%4	7%
Bianchi et al[22]	RTME	25	240 (170-420)	NA	6.5 (4-15)	0	16%	4%
	LTME	25	237 (170-545)	NA	6 (4-20)	4	24%	8%
Popescu et al[44]	RTME	38	208 (180-300)4	1004	8.1 ± 4.5	5.2	15.7%	5.2%
	LTME	84	182 (140-220)4	1504	8.4 ± 3.5	10.5	15.3%	7.1%
Kim et al[23]	RTME	100	385.3 ± 102.64	NA	11.7 ± 6.7	2	20%	8.2%
	LTME	100	297.3 ± 83.74	NA	14.4 ± 10	3	27%	11.1%
Park et al[45]	RTME	41	231.9 ± 61.44	NA	9.9	0	19.3%	9.7%
	LTME	82	168.6 ± 49.34	NA	9.4	0	29.3%	7.3%
Park et al[46]	RTME	52	233 ± 52.4	NA	10 ± 19.2	0	10%	9.6%
	LTME	123	158 ± 49.2	NA	15 ± 12.2	0	15%	5.6%
Baek et al[47]	RTME	41	296 (150-520)	200 (20-2000)	6.5 (2-33)	7.3	22%	8.6%
	LTME	41	315 (174-584)	300 (17-1000)	6.6 (3-20)	22	26.8%	2.9%
Kwak et al[48]	RTME	59	270 (241-325)4	NA	NA	0	32.2%	13.5%
	LTME	59	228 (177-254)4	NA	NA	3.4	27.1%	10.1%
Kim et al[25]	RTME	100	188 ± 454	NA	7.1 ± 2.1	0	26%	2%
	OTME	100	103 ± 234	NA	6.9 ± 1.5	03	27%	4%
Park et al[49]	RTME	40	235.5 ± 57.54	45.7 ± 40	10.6 ± 4.2	0	15%	7.5%
	LTME	40	185.4 ± 72.84	59.2 ± 35.8	11.3 ± 3.6	0	12.5%	5%
Kang et al[26]	RTME	165	309.7 ± 115.24	133 ± 192.34	10.8 ± 5.54	0.6	20.6%	7.3%
	LTME	165	277.8 ± 81.94	140.1 ± 216.44	13.5 ± 9.24	1.8	27.9%	10.8%
	OTME	165	252.6 ± 88.14	275.4 ± 368.84	16 ± 8.64	03	24.8%	3.4%
D’Annibale et al[27]	RTME	50	270 (240-315)	NA	8 (7-11)	0	10%	10%
	LTME	50	280 (240-350)	NA	10 (8-14)	12	22%	14%

¹Non-complicated/complicated cases;

²Abdominoperineal resections only;

³Conventional (open) approach;

⁴The original publication as statistically significant (P < 0.05). RTME: Robotic total mesorectal excision; LTME: Laparoscopic total mesorectal excision; RPME: Robotic partial mesorectal excision; OTME: Open total mesorectal excision; NA: Not available.

Table 3 Use of robotics in rectal cancer surgery - immediate oncological outcomes

Ref.	Type of procedure	Number of patients	Positivity of circumferential resection margin (%)	Distal resectionmargins, cm	Mean/median number of lymph nodes harvested
Hellan et al[28]	RTME	39	0	2.6 (0.4-7.5)	13 (7-28)
Choi et al[29]	RTME	13	0	4.7 ± 1.8	24.6 ± 16.7
Choi et al[19]	RTME	50	2	1.9 ± 1.1	20.6 ± 10
Ng et al[30]	RTME	8	0	> 2	15 (2-26)
deSouza et al[31]	RTME	44	0	NA	14 (5-45)
Pigazzi et al[32]	RTME	143	0.7	2.9 ± 1.8	14.1 (1-39)
Baek et al[33]	RTME	64	0	3.4 (0.2-10)	14.5 (3-28)
Zimmern et al[34]	RTME	58	NA	NA	11.8-15.3
Kang et al[20]	RTME	389	3.6	NA	15.7 ± 10
Koh et al[35]	RTME	19	5.3	0.8-1	17.8 ± 7.1
Leong et al[21]	RTME	29	6.8	0.8 (0-4)	16 (1-44)
Marecik et al[36]	RTME	5	0	-1	12.4
Alimoglu et al[24]	RTME	7	0	-1	16 (14-21)
Kang et al[37]	RTME	6	0	-1	20 (7-58)
Karahasanoglu et al[38]	RTME	30	0	4 (2-8)	15 (3-38)
Park et al[39]	RTME	30	0	NA	20 (14-25)
Du et al[40]	RTME	22	0	2.6 (1-5.5)	14.3 (8-27)
Pigazzi et al[41]	RTME	6	NA	3.8 (1.8-9)	14 (9-28)
	LTME	6	NA	3.5 (2.2-5)	17 (9-39)
Baik et al[18]	RTME	18	NA	4.0 ± 1.1	18 (6-49)
	LTME	18	NA	3.7 ± 1.1	22 (9-42)
Patriti et al[42]	RTME	29	0	2.1 ± 0.9	10.3 ± 4
	LTME	37	0	4.5 ± 7.2	11.2 ± 5
Baik et al[43]	RTME	56	7.2	4 (1-7)	17.5 (4-43)
	LTME	57	8.8	3 (1-9)	17 (4-53)
Bianchi et al[22]	RTME	25	0	2 (1.5-4.5)	18 (7-34)
	LTME	25	4	2 (1.8-3.5)	17 (8-37)
Popescu et al[44]	RTME	38	NA	Negative	11.7 ± 3.8
	LTME	84	NA	Negative	11.1 ± 3.2
Kim et al[23]	RTME	100	3	2.7 ± 1.9	14.7 ± 9.7
	LTME	100	2	2.6 ± 1.8	16.6 ± 9.1
Park et al[45]	RTME	41	1.2	2.1 ± 1.4	17.3 ± 7.7
	LTME	82	7.3	2.3 ± 1.5	14.2 ± 8.9
Park et al[46]	RTME	52	1.9	2.8 ± 1.9	19.4 ± 10.2
	LTME	123	2.4	3.2 ± 2.1	15.9 ± 10.1
Baek et al[47]	RTME	41	4.9	3.6 (0.4-10)	13.1 (3-33)
	LTME	41	2.4	3.8 (0.4-11)	16.2 (3-33)
Kwak [48]	RTME	59	1.7	2.2 (1.5-3)	20 (12-27)
	LTME	59	0	2 (1.2-3.5)	21 (14-28)
Kim et al[25]	RTME	100	1	2.7 ± 1.72	20 ± 6.9
	OTME	100	1	1.9 ± 1.32	19.6 ± 8.5
Park et al[49]	RTME	40	7.5	1.4 ± 0.9	12.9 ± 7.5
	LTME	40	5	1.3 ± 0.9	13.3 ± 8.6
Kang et al[26]	RTME	165	4.22	1.9 ± 1.4	15 ± 9.4
	LTME	165	6.72	2 ± 1.4	15.6 ± 9.1
	OTME	165	10.32	2.2 ± 1.7	17.4 ± 10.9
D’Annibale et al[27]	RTME	50	02	3 (2-7)	16.5 (11-44)
	LTME	50	122	3 (1-6)	13.8 (4-29)

¹Abdominoperineal resections only;

²The original publication as statistically significant (P < 0.05). RTME: Robotic total mesorectal excision; LTME: Laparoscopic total mesorectal excision; RPME: Robotic partial mesorectal excision; OTME: Open total mesorectal excision; NA: Not available.