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Gahunia S, Wyatt J, Powell SG, Mahdi S, Ahmed S, Altaf K. Robotic-assisted versus laparoscopic surgery for colorectal cancer in high-risk patients: a systematic review and meta-analysis. Tech Coloproctol 2025; 29:98. [PMID: 40198499 PMCID: PMC11978707 DOI: 10.1007/s10151-025-03141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 03/08/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND Evidence of superiority of robotic-assisted surgery for colorectal resections remains limited. This systematic review and meta-analysis aims to compare robotic-assisted and laparoscopic surgical techniques in high-risk patients undergoing resections for colorectal cancer. METHODS Systematic searches were performed using Pubmed, Embase and Cochrane library databases from inception until December 2024. Randomised and non-randomised studies reporting outcomes of robotic-assisted or laparoscopic resections in the following high-risk categories were included: obesity, male gender, the elderly, low rectal cancer, neoadjuvant chemoradiotherapy and previous abdominal surgery. Comparative meta-analyses for all sufficiently reported outcomes were completed. Risk of bias was assessed using the ROBINS-I and RoB 2 tools for non-randomised and randomised studies, respectively. RESULTS 48 studies, including a total of 34,846 patients were eligible for inclusion and 32 studies were utilised in the comparative meta-analyses. Conversion to open rates were significantly lower for robotic-assisted surgery in patients with obesity, male patients and patients with low rectal tumours (obese OR 0.41 [CI 0.32-0.51], p < 0.00001); male gender (OR 0.28 [CI 0.22-0.34], p < 0.00001); low tumours OR 0.10 [CI 0.02-0.58], p = 0.01). Length of stay was significantly reduced for robotic-assisted surgery in patients with obesity (SMD 0.25 [CI - 0.41 to - 0.09], p = 0.002). Operative time was significantly longer in all subgroups (obesity SMD 0.57 [CI 0.31-0.83], p < 0.0001; male gender SMD 0.77 [CI 0.17-1.37], p = 0.01; elderly SMD 0.50 [CI 0.18-0.83], p = 0.002; low rectal tumours SMD 0.48 [CI 0.12-0.84], p = 0.008; neoadjuvant chemoradiotherapy SMD 0.72 [CI 0.34-1.09], p = 0.0002; previous surgery SMD 1.55 [CI 0.05-3.06], p = 0.04). When calculable, blood loss, length of stay, complication rate and lymph node yield were comparable in all subgroups. CONCLUSIONS This review provides further evidence of non-inferiority of robotic-assisted surgery for colorectal cancer and demonstrates conversion rates are superior in specific, technically challenging operations.
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Affiliation(s)
- S Gahunia
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
| | - J Wyatt
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK
| | - S G Powell
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK
| | - S Mahdi
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - S Ahmed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - K Altaf
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
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Flaifel M, Eichenberg S, Mohandes B, Taha E, Kollmann L, Flemming S, Haberstroh A, Ortlieb N, Melling N, Neumann K, Taha-Mehlitz S, Poškus T, Frey DM, Cattin PC, Taha A, Zeindler J, Rosenberg R, Saad B, Honaker MD. The outcomes of robotic ileocolic resection in Crohn's disease compared with laparoscopic and open surgery: a meta-analysis and systematic review. Tech Coloproctol 2025; 29:88. [PMID: 40138014 PMCID: PMC11946954 DOI: 10.1007/s10151-025-03116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 01/30/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND This is the first review providing insights into the outcomes of robotic ileocolic resection for Crohn's disease, potentially guiding improved surgical decisions and patient outcomes and comparing outcomes with laparoscopic and open approaches. METHODS The review was registered prospectively with PROSPERO (CRD42024504839). A comprehensive search of MEDLINE, Embase, Scopus, and Cochrane Central databases for studies on robotic ileocolic resection for Crohn's disease from inception to February 2024 was conducted. Eligible studies included participants over 18 years of age with Crohn's disease undergoing robotic ileocolic resection. Data were extracted according to PRISMA guidelines. For single-arm analyses, the random-effects model was used, while two-arm analyses employed the inverse variance and Mantel-Haenszel methods. RESULTS The analysis included eight studies with 5760 patients, among whom 369 underwent robotic ileocolic resection. The mean operative time for robotic procedures was 226 min. Postoperative complications included ileus in 12.50% and wound complications in 7.00%, while reoperations and readmissions occurred in 3.60% and 13.20% of patients, respectively. When compared with laparoscopic procedures, robotic procedures showed shorter length of hospital stay and longer operative times but similar total complication, reoperation, and conversion rates. In contrast, robotic procedures had fewer total postoperative complications compared with open surgeries, despite longer operative times. CONCLUSIONS Robotic ileocolic resection for Crohn's disease, while having a longer operative time, results in fewer postoperative complications compared with open surgery and shows comparable outcomes to laparoscopic procedures with shorter hospital stays.
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Affiliation(s)
- M Flaifel
- School of Medicine, St. George's University of London, London, UK
| | - S Eichenberg
- Department of Visceral Surgery, Cantonal Hospital Baselland, Basel, Switzerland
| | - B Mohandes
- Department of General Surgery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - E Taha
- Department of Visceral, Gynecology and Pediatric Surgery, Al Qassim Health Cluster, Buraydah, Kingdom of Saudi Arabia
| | - L Kollmann
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - S Flemming
- Department for General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - A Haberstroh
- Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - N Ortlieb
- Data Science and Statistics, Medoc Swiss, Basel, Switzerland
| | - N Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Neumann
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - S Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - T Poškus
- Institute of Clinical Medicine, Vilnius University Hospital, Vilnius, Lithuania
| | - D M Frey
- Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland
| | - P C Cattin
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - A Taha
- Department of Visceral Surgery, Cantonal Hospital Baselland, Basel, Switzerland.
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland.
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
| | - J Zeindler
- Department of Visceral Surgery, Cantonal Hospital Baselland, Basel, Switzerland
| | - R Rosenberg
- Department of Visceral Surgery, Cantonal Hospital Baselland, Basel, Switzerland
| | - B Saad
- Department of Acute Medicine, Royal Lancaster Infirmary, Lancaster, UK
| | - M D Honaker
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Babu B, Singh J, Salazar González JF, Zalmai S, Ahmed A, Padekar HD, Eichemberger MR, Abdallah AI, Ahamed S I, Nazir Z. A Narrative Review on the Role of Artificial Intelligence (AI) in Colorectal Cancer Management. Cureus 2025; 17:e79570. [PMID: 40144438 PMCID: PMC11940584 DOI: 10.7759/cureus.79570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2025] [Indexed: 03/28/2025] Open
Abstract
The role of artificial intelligence (AI) tools and deep learning in medical practice in the management of colorectal cancer has gathered significant attention in recent years. Colorectal cancer, being the third most common type of malignancy, requires an innovative approach to augment early detection and advanced surgical techniques to reduce morbidity and mortality. With its emerging potential, AI improves colorectal cancer management by assisting with accuracy in screening, pathology evaluation, precision, and postoperative care. Evidence suggests that AI minimizes missed cases during colorectal cancer screening, plays a promising role in pathology and imaging diagnoses, and facilitates accurate staging. In surgical management, AI demonstrates comparable or superior outcomes to laparoscopic approaches, with reduced hospital stays and conversion rates. However, these outcomes are influenced by clinical expertise and other dependable factors, including expertise in implementing AI-based software and detecting possible errors. Despite these advancements, limited multicenter studies and randomized trials restrict the comprehensive evaluation of AI's true potential and integration into standard practice. We used Pubmed, Google Scholar, Cochrane Library, and Scopus databases for this review. The final number of articles selected, depending on inclusion and exclusion criteria, is 122. We included papers published in the English language, literature published in the last 10 years, and adult patient populations above 35 years with colorectal cancer. We thoroughly included randomized controlled trials, cohort studies, meta-analyses, systematic reviews, narrative reviews, and case-control studies. The use of AI paves the way for the adoption of more personalized medicine. This review highlights the advantages of AI at various disease stages for colorectal cancer patients and evaluates its potential for cost-effective implementation in clinical practice.
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Affiliation(s)
- Bijily Babu
- Clinical Research, Network Cancer Aid and Research Foundation, Cochin, IND
| | - Jyoti Singh
- Department of Medicine, American University of Barbados, Bridgetown, BRB
| | | | - Sadaf Zalmai
- Emergency Medicine, New York Presbyterian Hospital, New York, USA
| | - Adnan Ahmed
- Medicine and Surgery, York University, Bradford, CAN
| | - Harshal D Padekar
- General Surgery, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, IND
| | | | - Abrar I Abdallah
- Medicine and Surgery, Sulaiman Al Rajhi University, Al Bukayriyah, SAU
| | - Irshad Ahamed S
- General Surgery, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
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Berar M, Ciocan A, Moiș E, Furcea L, Popa C, Ciocan RA, Zaharie F, Puia C, Al Hajjar N, Caraiani C, Rusu I, Graur F. Comprehensive Overview of Molecular, Imaging, and Therapeutic Challenges in Rectal Mucinous Adenocarcinoma. Int J Mol Sci 2025; 26:432. [PMID: 39859149 PMCID: PMC11764815 DOI: 10.3390/ijms26020432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 12/20/2024] [Accepted: 12/31/2024] [Indexed: 01/27/2025] Open
Abstract
Rectal cancer is one of the most frequent malignancies worldwide. The most common histological type is adenocarcinoma, followed by mucinous adenocarcinoma. The outcome is less favorable for the mucinous type, yet the treatment course is the same. The aim of this systematic literature review is to assess existing information in order to improve survival in rectal mucinous adenocarcinoma (RMA) and establish a starting point for future research. A systematic search of PubMed, Google Scholar, and Web of Science online libraries was performed in October 2024, evaluating studies regarding clinicopathological and genetic features in connection with targeted treatment and survival outcomes in RMA, using the terms "rectal cancer", "rectum", "mucinous adenocarcinoma", or a combination of the terms. We selected 23 studies, 10 of them regarding the diagnostic implications and 13 discussing the treatment strategies and prognosis of this histological subtype. There were six studies addressing the imaging aspects, highlighting the distinct features of mucinous histology in MRI. The molecular specifics were detailed in four studies, outlining the molecular footprint. The prognosis and treatment course were addressed in 12 studies. The inflammation index prognosis, complete response to neoadjuvant chemotherapy, and surgical aspects were addressed individually in each study. We encapsulated the molecular and clinicopathological characteristics of RMA, as well as diagnostic and treatment approaches, to establish a baseline of references for the benefit of daily practice and further research.
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Affiliation(s)
- Mihaela Berar
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Andra Ciocan
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Emil Moiș
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Luminița Furcea
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Călin Popa
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Florin Zaharie
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Cosmin Puia
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Nadim Al Hajjar
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Cosmin Caraiani
- Department of Medical Imaging, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Ioana Rusu
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Florin Graur
- 3rd Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (M.B.); (E.M.); (L.F.); (C.P.); (F.Z.); (C.P.); (N.A.H.); (F.G.)
- Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
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Falola AF, Adeyeye A, Shekoni O, Oluwagbemi A, Effiong-John B, Ogbodu E, Dada OS, Ndong A. Robotic and laparoscopic minimally invasive surgery for colorectal cancer in Africa: an outcome comparison endorsed by the Nigerian society for colorectal disorders. Surg Endosc 2025; 39:122-140. [PMID: 39658673 DOI: 10.1007/s00464-024-11416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 11/03/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Minimally invasive surgery for colorectal cancer (CRC) offer superior outcomes compared to open surgery. This study aimed to review the robotic and laparoscopic procedures for CRC performed in Africa, and compare the mean surgery duration, blood loss, hospital stay, rate of conversion, and prevalence of morbidity and mortality. This is the first study to compare the outcomes of robotic and laparoscopic surgeries for CRC in Africa. METHODS A systematic review following the PRISMA guidelines was conducted. PubMed, Google Scholar, Web of Science, AJOL, EMBASE, and CENTRAL were searched, identifying 2,259 publications, 33 of which were deemed eligible. Statistical analysis of outcomes was performed using "R". Methodological quality of the included studies was assessed using the Cochrane ROBINS-I tool. RESULTS The minimally invasive approach has been applied for CRC treatment in seven African countries: Algeria, Cameroon, Egypt, Morocco, Nigeria, Senegal, and South Africa. Laparoscopic surgeries accounted for 1,485 (95%) of cases, while 71 (5%) were robotic. Robotic procedures were associated with a longer surgery duration (256.41 min vs. 190.45 min, p < 0.0001), higher blood loss (226.48 mL vs. 141.55 mL, p < 0.0001), and a shorter hospital stay (4.52 days vs. 6.06 days, p = 0.85). Robotic procedures had a lower rate of conversion (3% vs. 8%, p = 0.29) and a lower prevalence of morbidity (19% vs. 26%, p = 0.26). Wound infection (24.49%) and ileus (57.14%) were the most common complications following laparoscopic and robotic procedures, respectively. There was no mortality from robotic surgeries; however, a prevalence of 0.39% (95% CI: 0;1.19) was recorded from laparoscopy. CONCLUSIONS This study establishes and compares the outcomes of advances in the treatment of CRC in the African setting, providing insights for policymakers, healthcare providers, and international organizations to make decisions regarding optimizing care for CRC patients in Africa.
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Affiliation(s)
- Adebayo Feranmi Falola
- University of Ibadan College of Medicine, Ibadan, Nigeria.
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria.
| | - Ademola Adeyeye
- Significant Polyp and Early Colorectal Cancer Service, King's College Hospital, London, UK
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Medicine and Surgery, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Oluwatobi Shekoni
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | | | - Blessing Effiong-John
- University of Ibadan College of Medicine, Ibadan, Nigeria
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Emmanuella Ogbodu
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Asaba Specialist Hospital, Asaba, Nigeria
| | - Oluwasina Samuel Dada
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Abdourahmane Ndong
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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Zhang L, Yang L, Wang Y, Sun M, Tao Y. Clinical comparative study of robot-assisted and traditional laparoscopic surgery in patients with cervical cancer: a retrospective cohort study. BMC Surg 2024; 24:423. [PMID: 39731015 DOI: 10.1186/s12893-024-02716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 12/10/2024] [Indexed: 12/29/2024] Open
Abstract
BACKGROUND A new era in minimally invasive surgery has been ushered in by Leonardo's robot surgical system, but the safety and effectiveness in cervical cancer is lake of evidence. This study aimed to compare the safety, effectiveness, and cost-effectiveness of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in patients with cervical cancer. METHODS Patients with cervical cancer who had radical surgery at the first affiliated Hospital of Chongqing Medical University between January 2017 and June 2022 were enrolled. Patients in the LRH and RRH groups were matched 1:1 using propensity score matching (PSM), all patients were followed up to September 2023, cancer recurrence occurred or death, whichever came first. RESULTS 522 cervical cancer patients were enrolled in this study, 261 of whom were in the LRH group and 261 of whom were in the RRH group. Univariate analysis showed that the RRH group had less intraoperative blood loss, shorter operation time and hospital stay, lower incidence of composite complications and urinary retention, but had higher hospitalization costs. Multivariate Logistic regression analysis showed that LRH was an independent protective factor for composite complications (OR 1.531; 95%CI,1.022 to 2.295; P = .039). Cox regression analysis with cancer recurrence as the endpoint showed that LRH (HR 0.320; 95%CI,0.255 to 0.401; P < .001) and longer operation time (HR 0.995; 95%CI,0.993 to 0.997; P < .001) reduced 68% and 5% risk of cancer recurrence ; results also indicated that the older age (HR 1.017; 95%CI,1.007 to 1.027; P = .001) and postoperative complications (HR 22.410; 95%CI,16.019 to 31.350; P < .001) would increase 224% recurrence risk of cancer recurrence. CONCLUSIONS Both LRH and RRH demonstrated good short-term efficacy, with RRH outperforming LRH in terms of reduced intraoperative bleeding, shorter hospital stays and operation times, and fewer composite complications. However, the RRH group faces a higher risk of early cancer recurrence and incurs greater expenses. In summary, comprehensive long-term prospective studies are needed to thoroughly explore the effectiveness and safety of both LRH and RRH.
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Affiliation(s)
- Lijuan Zhang
- Department of Phase I Clinical Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lihong Yang
- Department of Phase I Clinical Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yan Wang
- Department of Phase I Clinical Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Minghong Sun
- Department of Phase I Clinical Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yi Tao
- Department of Phase I Clinical Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Wyatt J, O'Connell E, Choi M, Powell SG, Hanchanale V, Ahmed S, Javed MA. Open versus robotic-assisted techniques for multivisceral pelvic resections of locally advanced or recurrent colorectal and anal cancers: short-term outcomes from a single centre. Tech Coloproctol 2024; 28:161. [PMID: 39560793 PMCID: PMC11576618 DOI: 10.1007/s10151-024-03044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 10/13/2024] [Indexed: 11/20/2024]
Abstract
BACKGROUND Pelvic exenterations are now established as a standard of care for locally advanced and recurrent rectal cancer. Traditionally, these radical and complex operations have been performed via an open approach, but with the increasing expertise in robotic-assisted surgery (RAS), there is scope to perform such cases robotically. This study compares outcomes from open and RAS pelvic exenterations. METHODS This retrospective observational study includes all pelvic exenterations for locally advanced or recurrent colorectal cancers performed in a single centre between September 2018 and September 2023. Cases were grouped into open or RAS surgery and classified in terms of operative extent and complexity. The primary outcome was resection margin status. Secondary outcomes were postoperative morbidity, length of stay and blood loss. RESULTS Thirty-three patients were included. Nineteen (57.6%) cases utilised an open technique, and 14 (42.4%) used RAS. Patient characteristics and operative complexity were equivalent between groups. R0 rate (63.1% vs 71.4%, p = 0.719), median haemoglobin drop (19 (11-30) g/L vs 13 (5-26) g/L, p = 0.208) and postoperative morbidity (18/19 (94.7%) vs 9/14 (64.3%), p = 0.062) were equivalent. Length of stay (16.0 days (8-25) vs 9.5 days (6-16), p = 0.047) was shorter in the RAS group. CONCLUSIONS Short-term surgical and histopathological outcomes are equivalent in this small cohort of patients. This study suggests that RAS may be a safe and effective method for performing pelvic exenterations for colorectal malignancies. Larger-scale and robustly designed prospective studies are required to confirm these preliminary findings and report on long-term oncological outcomes.
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Affiliation(s)
- J Wyatt
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK
| | - E O'Connell
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - M Choi
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - S G Powell
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK
| | - V Hanchanale
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - S Ahmed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
| | - M A Javed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L1 8JX, UK
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Thrikandiyur A, Kourounis G, Tingle S, Thambi P. Robotic versus laparoscopic surgery for colorectal disease: a systematic review, meta-analysis and meta-regression of randomised controlled trials. Ann R Coll Surg Engl 2024; 106:658-671. [PMID: 38787311 PMCID: PMC11528374 DOI: 10.1308/rcsann.2024.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Robotic surgery (RS) is gaining prominence in colorectal procedures owing to advantages like three-dimensional vision and enhanced dexterity, particularly in rectal surgery. Although recent reviews report similar outcomes between laparoscopic surgery (LS) and RS, this study investigates the evolving trends in outcomes over time, paralleling the increasing experience in RS. METHODS A systematic review, meta-analysis and meta-regression were conducted of randomised controlled trials exploring postoperative outcomes in patients undergoing RS or LS for colorectal pathology. The primary outcome measure was postoperative complications. Risk of bias was evaluated using the Cochrane Collaboration's assessment tool. Randomised controlled trials were identified from the PubMed®, Embase® and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases via the Cochrane Central Register of Controlled Trials. RESULTS Of 491 articles screened, 13 fulfilled the inclusion criteria. Meta-analysis of postoperative complications revealed no significant difference between RS and LS (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.79 to 1.18, p=0.72). Meta-regression analysis of postoperative complications demonstrated a significant trend favouring RS over time (yearly change in Ln(RR): -0.0620, 95% CI: -0.1057 to -0.0183, p=0.005). Secondary outcome measures included operative time, length of stay, blood loss, conversion to open surgery, positive circumferential resection margins and lymph nodes retrieved. The only significant findings were shorter operative time favouring LS (mean difference: 41.48 minutes, 95% CI: 22.15 to 60.81 minutes, p<0.001) and fewer conversions favouring RS (RR: 0.57, 95% CI: 0.37 to 0.85, p=0.007). CONCLUSIONS As experience in RS grows, evidence suggests an increasing safety profile for patients. Meta-regression revealed a significant temporal trend with complication rates favouring RS over LS. Heterogeneous reporting of complications hindered subgroup analysis of minor and major complications. LS remains quicker. Rising adoption of RS coupled with emerging evidence is expected to further elucidate its clinical efficacy.
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Affiliation(s)
| | | | | | - P Thambi
- South Tees Hospitals NHS Foundation Trust, UK
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9
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Hsu ATW, Zion M, Powell J, D'Adamo CR, Feinman M, Felton J, Wolf JH. Association of robotic surgery with early discharge, readmission, and complications in elective colectomy: an analysis of NSQIP data from 2012 to 2021. J Robot Surg 2024; 18:366. [PMID: 39402423 DOI: 10.1007/s11701-024-02121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 09/28/2024] [Indexed: 12/25/2024]
Abstract
Background Early discharge (ED) after colectomy has become a target outcome for multiple reasons, but the factors associated with ED are not well characterized. This study investigated the factors associated with ED and evaluated the impact of ED on overall outcome. Methods Data from ACS-NSQIP were used to identify patients who underwent non-emergent colectomy from 2012 to 2021. ED was defined as length of stay ≤ 2 days. Unpaired t-tests, chi-square tests and adjusted multivariate logistic regression modeling were used to estimate associated factors for ED. Bounceback readmission was defined as readmission within 7 days of discharge. Results In this cohort of 282,490 patients, 43,137 (15.3%) met the criteria for ED. Robotic colectomy (OR 14.35; 95% CI [13.63-15.12]) was more strongly associated with ED than any other patient characteristic, including laparoscopic colectomy (6.82 [6.51-7.14], ref open colectomy). ED vs. non-ED patients had lower rates of 30-day (5.84 vs. 10.37%, p < 0.01) and bounceback (3.56 vs. 5.75%, p < 0.01) readmissions, overall complications (5.65 vs. 18.63%, p < 0.01) and post-discharge complications (4.21 vs. 7.49%, p < 0.01). Conclusions Robotic surgery was the variable most strongly associated with ED, with greater odds of ED compared to both laparoscopic and open colectomy. Patients who had ED after robotic surgery had lower rates of complications and readmission compared to non-ED patients.
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Affiliation(s)
- Angela Ting-Wei Hsu
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Mofi Zion
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA
| | - Jocelyn Powell
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA
| | - Christopher R D'Adamo
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcie Feinman
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Jessica Felton
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Joshua H Wolf
- Sinai Hospital of Baltimore, Lifebridge Health, 2435 Belvedere Ave, Baltimore, MD, 2121, USA.
- George Washington University School of Medicine, Washington, DC, USA.
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10
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Massias S, Vadhwana B, Arjomandi Rad A, Hollingshead J, Patel V. Feasibility, clinical outcomes, and learning curves of robotic-assisted colorectal cancer surgery in a high-volume district general hospital: a cohort study. Ann Med Surg (Lond) 2024; 86:5744-5749. [PMID: 39359778 PMCID: PMC11444557 DOI: 10.1097/ms9.0000000000002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/25/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Robotic-assisted surgery (RAS) is one of the most influential surgical advances with widespread clinical and health-economic benefits. West Hertfordshire Teaching Hospital NHS Trust was the first in the UK to simultaneously integrate two CMR Surgical Versius robots. This study aims to investigate clinical outcomes of RAS, explore surgeon learning curves and assess the feasibility of implementation within a district general hospital (DGH). Methods A prospective cohort study of 100 consecutive patient data were collected between July 2022 and August 2023, including demographics, operative and clinical variables, and compared with laparoscopic surgery (LS) data from the National Bowel Cancer Audit. Surgeon learning curves were analysed using sequential surgical and console times. Results In the RAS cohort, the median age was 70 (IQR 57-78 years) and 60% were male. Retrieval of a minimum of 12 lymph nodes significantly increased in RAS compared to LS (95% vs. 88%, P=0.05). The negative mesorectal margin rate was similar between RAS and LS (97% vs. 91%, P=0.10), as well as length of stay greater than 5 days (42% vs. 39%, P=0.27). For anterior resections performed by the highest volume surgeon (n=16), surgical time was reduced over 1 year by 35% (304.9-196.9 min), whilst console time increased by 111% (63.0-132.8 min). Conclusions Key quality performance indicators were either unchanged or improved with RAS. There is potential for improved theatre utilisation and cost-savings with increased RAS. This study demonstrates the feasibility and easy integration of robotic platforms into DGHs, offering wider training opportunities for the next generation of surgeons.
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Affiliation(s)
- Samuel Massias
- Department of Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital
| | - Bhamini Vadhwana
- Department of Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London
| | - Arian Arjomandi Rad
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - James Hollingshead
- Department of Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital
| | - Vanash Patel
- Department of Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London
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Chung KC, Wu KL, Su YL, Cheng KC, Tang CE, Song LC, Chen HH, Lee KC. Outcomes of Robot-Assisted Versus Laparoscopic Surgery for Colorectal Cancer in Adults Aged 75 Years and Older: A Propensity Score-Matched Analysis of the US Nationwide Inpatient Sample. Dis Colon Rectum 2024; 67:1121-1130. [PMID: 38848125 DOI: 10.1097/dcr.0000000000003374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
BACKGROUND Robot-assisted surgery has been increasingly adopted in colorectal cancer resection. OBJECTIVE The study aimed to compare the inpatient outcomes of robot-assisted versus conventional laparoscopic colorectal cancer resection in patients aged 75 years and older. DESIGN A retrospective, population-based study. SETTINGS This study analyzed data from the United States Nationwide Inpatient Sample from 2005 to 2018. PATIENTS Patients with colorectal cancer aged 75 years and older and who underwent robot-assisted or conventional laparoscopic resection. MAIN OUTCOME MEASURES Postoperative complications, prolonged length of stay, and total hospital costs were assessed. RESULTS Data from 14,108 patients were analyzed. After adjustment, any postoperative complications (adjusted OR = 0.87; 95% CI, 0.77-0.99; p = 0.030) and prolonged length of stay (adjusted OR = 0.78; 95% CI, 0.67-0.91; p = 0.001) were significantly less in the robotic than the laparoscopic group. In addition, robotic surgery was associated with significantly higher total hospital costs (26.06 USD greater cost; 95% CI, 21.35-30.77 USD; p < 0.001). LIMITATIONS The analysis was limited by its retrospective and observational nature, potential coding errors, and the lack of intraoperative factors, such as operative time, laboratory measures, and information on surgeons' experience. CONCLUSIONS In the United States, in patients with colorectal cancer aged 75 years and older who were undergoing tumor resections, compared to conventional laparoscopic surgery, robotic surgery is associated with better inpatient outcomes in terms of complication rate and risk of prolonged length of stay. This finding is especially true among patients with colon cancer. However, robotic surgery is associated with higher total hospital costs. See Video Abstract . RESULTADOS DE LA CIRUGA ASISTIDA POR ROBOT FRENTE A LA CIRUGA LAPAROSCPICA PARA EL CNCER COLORRECTAL EN ADULTOS AOS DE EDAD UN ANLISIS EMPAREJADO POR PUNTUACIN DE PROPENSIN DE LA MUESTRA NACIONAL DE PACIENTES HOSPITALIZADOS DE ESTADOS UNIDOS ANTECEDENTES:La cirugía asistida por robot se ha adoptado cada vez más en la resección del cáncer colorrectal.OBJETIVO:El estudio tuvo como objetivo comparar los resultados hospitalarios de la resección del cáncer colorrectal asistida por robot versus la laparoscópica convencional en pacientes ≥ 75 años.DISEÑO:Estudio retrospectivo de base poblacional.AJUSTES:Este estudio analizó datos de la Muestra Nacional de Pacientes Hospitalizados de Estados Unidos de 2005 a 2018.PACIENTES:Pacientes con cáncer colorrectal ≥ 75 años y sometidos a resección laparoscópica convencional o asistida por robot.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron las complicaciones posoperatorias, la duración prolongada de la estancia hospitalaria y los costos hospitalarios totales.RESULTADOS:Se analizaron datos de 14.108 pacientes. Después del ajuste, cualquier complicación posoperatoria (aOR = 0,87; IC del 95 %: 0,77-0,99, p = 0,030) y duración prolongada de la estancia hospitalaria (aOR = 0,78; IC del 95 %: 0,67-0,91, p = 0,001) fueron significativamente menores en el grupo robótico que el grupo laparoscópico. Además, la cirugía robótica se asoció con costos hospitalarios totales significativamente mayores ($26,06 USD mayor costo; IC 95%: 21,35-30,77 USD, p < 0,001).LIMITACIONES:El análisis estuvo limitado por su naturaleza retrospectiva y observacional, posibles errores de codificación y la falta de factores intraoperatorios como el tiempo operatorio, medidas de laboratorio e información sobre la experiencia de los cirujanos.CONCLUSIONES:En Estados Unidos, los pacientes con cáncer colorrectal ≥ 75 años que se sometieron a resecciones tumorales, en comparación con la cirugía laparoscópica convencional, la cirugía robótica se asocia con mejores resultados hospitalarios en términos de tasa de complicaciones y riesgo de estadía prolongada, especialmente entre pacientes con cáncer de colon. Sin embargo, la cirugía robótica se asocia a costes hospitalarios totales más elevados. (Traducción-Yesenia Rojas-Khalil ).
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Affiliation(s)
- Kuan-Chih Chung
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Kuen-Lin Wu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Yu-Li Su
- Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Kung-Chuan Cheng
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Chien-En Tang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Ling-Chiao Song
- Division of Colon and Rectal Surgery, Department of Surgery, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hong-Hwa Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Ko-Chao Lee
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
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Schena CA, Luzzi AP, Laterza V, De Simone B, Aisoni F, Gavriilidis P, Catena F, Coccolini F, Morciano F, Rosa F, Marchegiani F, de'Angelis N. Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections? A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:603-613. [PMID: 38962886 DOI: 10.1089/lap.2024.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background: The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. Methods: MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes. Results: Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes. Conclusions: Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Andrea-Pierre Luzzi
- Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Università di Genova, Genoa, Italy
| | - Vito Laterza
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Filippo Aisoni
- Unit of Emergency Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust,, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Francesca Morciano
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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13
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Iaquinandi F, Pini R, Sabbatini F, Toti JMA, Garofalo F, La Regina D, Mongelli F. Robotic-assisted treatment of paraesophageal hernias in the emergency setting: a retrospective study. J Robot Surg 2024; 18:228. [PMID: 38809354 DOI: 10.1007/s11701-024-01975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
Emergency treatment of paraesophageal hernias can be carried out through laparotomy or minimally invasive approaches, however, evidence in this regard is weak. The aim of our study was to assess safety and feasibility of the robotic-assisted treatment of paraesophageal hernias in the emergency setting. At the Bellinzona e Valli Regional Hospital, Switzerland, we conducted a retrospective analysis of patients operated on from January 2020 to January 2024 with robotic surgery for emergency presentation of paraesophageal hernias. Demographic and clinical details, operative techniques, and postoperative outcomes were collected and analyzed. Out of 82 patients who underwent robotic-assisted paraesophageal hernia repair, 17 were treated in the emergency setting. Median age was 79 years (IQR 77-85), 3 (17.6%) patients were male, and median BMI was 23.9 kg/m2 (IQR 21.0-26.0). Most frequent presentation symptoms were pain (100%), regurgitation (88.2%), and dyspnea (17.6%). No intraoperative complication, conversion to open surgery or stomach resections were recorded. Two complications of grade 3 according to the Clavien-Dindo classification and one of grade 2 occurred; all were successfully treated until resolution. The median length of hospital stay was 8 days (IQR 5-16). After a mean follow-up of 15.9 months (IQR 6.5-25.6) only two small axial asymptomatic recurrences that required no treatment. Despite limitations, our study demonstrated a very low rate of intra- and postoperative complications, likely supporting the safety and feasibility of robotic-assisted treatment for paraesophageal hernias in emergency settings. Larger studies with a control arm are needed to validate our initial findings.
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Affiliation(s)
- Fabiano Iaquinandi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Flaminia Sabbatini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Johannes Maria Alberto Toti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, via Tesserete 46, 6900, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland.
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Ingham AR, Kong CY, Wong TN, McSorley ST, McMillan DC, Nicholson GA, Alani A, Mansouri D, Chong D, MacKay GJ, Roxburgh CSD. Robotic-assisted surgery for left-sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study. Surg Endosc 2024; 38:2577-2592. [PMID: 38498212 PMCID: PMC11078791 DOI: 10.1007/s00464-024-10749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/10/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS. METHODS Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models. RESULTS A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21-0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26-0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26-0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033). CONCLUSIONS The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.
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Affiliation(s)
- Abigail R Ingham
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Chia Yew Kong
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Tin-Ning Wong
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Stephen T McSorley
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Donald C McMillan
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Gary A Nicholson
- Department of General Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Ahmed Alani
- Department of General Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - David Mansouri
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - David Chong
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Graham J MacKay
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Campbell S D Roxburgh
- Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
- Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
- Academic Unit of Surgery, School of Cancer Sciences, Room 2.60, Level 2 New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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15
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Martins RS, Fatimi AS, Mahmud O, Mahar MU, Jahangir A, Jawed K, Golani S, Siddiqui A, Aamir SR, Ahmad A. Quality of life after robotic versus conventional minimally invasive cancer surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:171. [PMID: 38598102 DOI: 10.1007/s11701-024-01916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
Optimizing postoperative quality of life (QoL) is an essential aspect of surgical oncology. Minimally invasive surgery (MIS) decreases surgical morbidity and improves QoL outcomes. This meta-analysis aimed to compare post-operative QoL after oncologic resections using different MIS modalities. The PubMed, Embase, Scopus, and CENTRAL databases were searched for articles that compared post-operative QoL in patients undergoing video-assisted thoracoscopic (VATS) or laparoscopic surgery (LS) versus robotic surgery (RS) for malignancy. Quality assessment was performed using the ROBINS-I and Cochrane Risk of Bias 2 (RoB-2) tools. Meta-analysis was performed using an inverse-variance random effects model. 27 studies met the inclusion criteria, including 5 randomized controlled trials (RCTs). 15 studies had a low risk of bias, while 11 had a moderate risk of bias and 1 had serious risk of bias. 8330 patients (RS: 5090, LS/VATS: 3240) from across 25 studies were included in the meta-analysis. Global QoL was significantly better after robotic surgery in the pooled analysis overall (SMD: - 0.28 [95% CI: - 0.49, - 0.08]), as well as in the prostatectomy and gastrectomy subgroups. GRADE certainty of evidence was low. Analysis of EPIC-26 subdomains also suggested greater sexual function after robotic versus laparoscopic prostatectomy. Robotic and conventional MIS approaches produce similar postoperative QoL after oncologic surgery for various tumor types, although advantages may emerge in some patient populations. Our results may assist surgeons in counseling patients who are undergoing oncologic surgery.
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Affiliation(s)
- Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network, Edison, NJ, USA
| | | | - Omar Mahmud
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | | | - Arshia Jahangir
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Kinza Jawed
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Shalni Golani
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Ayra Siddiqui
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | | | - Ali Ahmad
- Department of Surgery, School of Medicine-Wichita, University of Kansas, Wichita, KS, 67214, USA.
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Alkhamis A, Soliman D, Alkandari O, Alrashed A, Alansari M, Alsadder K, Chamkha Z, Souza D, AlShaban B, Alsafran S, Almazeedi S. Outcomes in robotic-assisted compared to laparoscopic-assisted colorectal surgery in a newly established colorectal tertiary center: a retrospective comparative cohort study. J Robot Surg 2024; 18:152. [PMID: 38564083 DOI: 10.1007/s11701-024-01908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
The robotic platform matches or surpasses laparoscopic surgery in postoperative results. However, limited date and slow adoption are noticed in the middle east. We aimed to report outcomes of robotic and laparoscopic colorectal surgery performed by fellowship-trained robotic colorectal surgeons and compare it to larger more experienced centers. Retrospective review of prospectively collected data between 2021 and 2023 of 107 patients who had robotic-assisted or laparoscopic-assisted colorectal surgery was included in the study. The outcomes were overall morbidity, serious morbidity, mortality, conversion to open, length of hospital stay, and the quality of oncological specimen. Of 107 patients, 57 were in the robotic and 50 were in the laparoscopic surgery groups. Overall, there were no significant differences in overall morbidity (46.8 vs. 53.2%, p = 0.9), serious morbidity (10.5 vs. 8%, p = 0.7), or mortality (0 vs. 4%, p = 0.2). Regarding oncological outcomes, there were no significant difference between the two groups regarding the number of lymph node harvested (17.7 ± 6.9 vs 19.0 ± 9.7, p = 0.5), R0 resections (92.7 vs. 87.1%, p = 0.5), and the rate of complete mesorectal excision (92.7 vs. 71.4%, p = 0.19). The study found that the robotic group had an 86% reduction in conversion rate to open surgery compared to the laparoscopic group, despite including more obese and physically dependent patients (OR = 0.14, 95% CI 0.03-0.7, p = 0.01). Robotic surgery appears to be a safe and effective as laparoscopic surgery in smaller colorectal surgery programs led by fellowship-trained robotic surgeons, with outcomes comparable to those of larger programs.
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Affiliation(s)
- Ahmed Alkhamis
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, State of Kuwait, Kuwait City, Kuwait.
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait.
| | - Diaa Soliman
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
- Department of General Surgery, University of Arizona, Tucson, AZ, USA
| | - Omar Alkandari
- Kuwait Institute for Medical Specialization, Ministry of Health, Kuwait City, Kuwait
| | - Ahmad Alrashed
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Mohammad Alansari
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Khaled Alsadder
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Zeinab Chamkha
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Dante Souza
- Department of Surgery, TriHealth Good Samaritan Hospital, Cincinnati, OH, USA
| | - Bader AlShaban
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Salman Alsafran
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, State of Kuwait, Kuwait City, Kuwait
- Endocrine Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Sulaiman Almazeedi
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
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Kim HJ, Choi GS, Park JS, Park SY, Song SH, Lee SM, Jeong MH. Comparison of the efficacy and safety of single-port versus multi-port robotic total mesorectal excision for rectal cancer: A propensity score-matched analysis. Surgery 2024; 175:297-303. [PMID: 38036394 DOI: 10.1016/j.surg.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND It is unknown whether the da Vinci single-port system performs similarly to the previous multi-port system during complicated procedures, such as rectal cancer surgery. Therefore, we compared the short-term clinical outcomes of single-port and multi-port robotic total mesorectal excision for the treatment of rectal cancer. METHODS This retrospective study reviewed 128 patients who underwent robotic total mesorectal excision between July 2020 and June 2022, of whom 84 (42 each: single-port versus multi-port) were included in the propensity score-matched cohort. Perioperative and pathologic outcomes were compared between groups. RESULTS Median tumor height was similar between groups (single-port versus multi-port, 5.9 ± 2.1 vs 5.6 ± 1.8 cm, P = .719). Preoperative chemoradiotherapy was performed equally. The total operative time was less (160.0 ± 42.2 minutes vs 199.6 ± 78.6 minutes, P = .005), the total length of incision was shorter (4.0 ±0.3 vs 5.4 ± 0.7 cm, P = .003), postoperative hospital stay was shorter (6.2 ±1.7 vs 7.2 ±2.8 days, P = .050), and C-reactive protein levels on postoperative day 3 trended to be lower (7.3 ± 4.7 vs 8.9 ± 5.6 mg/L, P = .096) in the single-port group, compared with the multi-port group. Postoperative complications did not differ between groups (single-port versus multi-port, 11.9% vs 16.6%, P = .864). Anastomotic leakage occurred in 1 and 2 patients in the single-port and multi-port groups, respectively. The circumferential resection margins were positive in 1 patient in the multi-port group. CONCLUSION The perioperative outcomes of single-port robotic total mesorectal excision were comparable to those of multi-port robotic TME. The single-port robot can be considered a surgical option for treating rectal cancer.
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Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Ho Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Min Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Hye Jeong
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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18
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Yao Q, Sun QN, Ren J, Wang LH, Wang DR. Comparison of robotic‑assisted versus conventional laparoscopic surgery for mid-low rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2023; 149:15207-15217. [PMID: 37580404 DOI: 10.1007/s00432-023-05228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Scarce research has reported the comparison between robotic and laparoscopic surgery in mid-low rectal cancer. Therefore, this meta-analysis is aimed to compare the safety and efficacy of the two surgical approaches. METHODS A comprehensive search of the databases (PubMed, EMBASE, Cochrane, and Web of Science) was performed for studies comparing robotic and laparoscopic surgery. The outcomes of interest acquired from eight articles included three aspects: intraoperative conditions, postoperative status of patients, and complications. All data (robotic = 1350 patients, laparoscopic = 1330 patients) enrolled were analyzed using Rev Man 5.4. RESULTS Compared to the laparoscopic group, the robotic group indicated a noticeable superiority in estimated blood loss (P < 0.0001), number of lymph nodes dissected (P = 0.004), time to first flatus (P = 0.001), time to first fluid diet (P = 0.001), hospital stay (P < 0.0001), conversion (P = 0.009), and urinary retention (P = 0.0006), but devoted much more operation time (P = 0.0004). CONCLUSION Robotic surgery was associated with superiority over laparoscopic surgery in increasing surgical safety, accelerating postoperative recovery, and reducing complications, which suggested that robotic surgery could be a safe and effective method for treating mid-low rectal cancer.
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Affiliation(s)
- Qing Yao
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Qian-Nan Sun
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
- Medical Research Center of Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Liu-Hua Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Dao-Rong Wang
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China.
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19
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Xu J, Mohan HM, Fleming C, Larach JT, Apte SS, Cohen LCL, Miskovic D, Jiang W, Heriot AG, Warrier SK. Complete mesocolic excision versus standard resection for colon cancer: a systematic review and meta-analysis of perioperative safety and an evaluation of the use of a robotic approach. Tech Coloproctol 2023; 27:995-1005. [PMID: 37414915 DOI: 10.1007/s10151-023-02838-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches. METHODS Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches. RESULTS There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien-Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54). CONCLUSIONS Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this. PROSPERO ID CRD42021287065.
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Affiliation(s)
- J Xu
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.
| | - H M Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Austin Health, Melbourne, VIC, Australia
| | - C Fleming
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - J T Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - L C L Cohen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | | | - W Jiang
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - A G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - S K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
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20
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Brunner M, ElGendy A, Denz A, Weber G, Grützmann R, Krautz C. [Robot-assisted visceral surgery in Germany : Analysis of the current status and trends of the last 5 years using data from the StuDoQ|Robotics registry]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:940-947. [PMID: 37500803 PMCID: PMC10587021 DOI: 10.1007/s00104-023-01940-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Robot-assisted systems have been increasingly used in general surgery for several years. Accordingly, the number of systems installed in Germany has also rapidly increased. While around 100 robot-assisted systems were used in German hospitals in 2018, this figure had already risen to more than 200 by 2022. The aim of this article is to present the current state of development and trends in robotic surgery in Germany. For this purpose, data from the StuDoQ|Robotics register were analyzed. Furthermore, a descriptive analysis of concomitant diagnosis-related groups (DRG) data was carried out via the Federal Statistical Office (Destatis), for a better assessment of the representativeness of the StuDoQ|Robotics register data. In both data sets, the annual number of robot-assisted visceral surgery procedures in Germany steadily increased. Compared to the DRG data, only 3.7% up to a maximum of 36.7% of all robot-assisted procedures performed were documented in the StuDoQ|Robotics register, depending on the type of procedure. Colorectal resections were the most frequent robot-assisted procedures (StuDoQ: 32.5% and 36.7% vs. DRG data: 24.2% and 29.7%) and had, for example, low mortality rates (StuDoQ: 1% and 1% vs. DRG data: 2.3% and 1.3%). Due to the low coverage rates of robot-assisted esophageal, gastric, pancreatic and liver interventions, no valid statements could be derived from the StuDoQ data for these areas. With the current coverage rates, the informative value of the StuDoQ|Robotics register is considerably limited for some types of intervention. In the future, measures should therefore be explored that lead to a significant increase in the coverage rates.
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Affiliation(s)
- Maximilian Brunner
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
| | - Amr ElGendy
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Axel Denz
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Georg Weber
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Robert Grützmann
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Christian Krautz
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland
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21
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Huang Z, Huang S, Huang Y, Luo R, Liang W. Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials. Front Oncol 2023; 13:1273378. [PMID: 37965455 PMCID: PMC10641393 DOI: 10.3389/fonc.2023.1273378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction There is still controversy on whether or not robot-assisted colorectal surgery (RACS) have advantages over laparoscopic-assisted colorectal surgery(LACS). Materials and methods The four databases (PubMed, Embase, Web of Science and Cochrane Library)were comprehensively searched for randomized controlled trials (RCTs) comparing the outcomes of RACS and LACS in the treatment of colorectal cancer from inception to 22 July 2023. Results Eleven RCTs were considered eligible for the meta-analysis. Compared with LACS,RACS has significantly longer operation time(MD=5.19,95%CI: 18.00,39.82, P<0.00001), but shorter hospital stay(MD=2.97,95%CI:-1.60,-0.33,P = 0.003),lower conversion rate(RR=3.62,95%CI:0.40,0.76,P = 0.0003), lower complication rate(RR=3.31,95%CI:0.64,0.89,P=0.0009),fewer blood loss(MD=2.71,95%CI:-33.24,-5.35,P = 0.007),lower reoperation rate(RR=2.12, 95%CI:0.33,0.96,P=0.03)and longer distal resection margin(MD=2.16, 95%CI:0.04,0.94, P = 0.03). There was no significantly difference in harvested lymph nodes, the time of first flatus, the time of first defecation,the time of first resume diet, proximal resection margin, readmission rates, mortalities and CRM+ rates between two group. Conclusions Our study indicated that RACS is a feasible and safe technique that can achieve better surgical efficacy compared with LACS in terms of short-term outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023447088.
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Affiliation(s)
- Zhilong Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Shibo Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yanping Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Raoshan Luo
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, Min BS, Kim NK, Kim SH, Lee KY. Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers: The COLRAR Randomized Controlled Trial. Ann Surg 2023; 278:31-38. [PMID: 36594748 DOI: 10.1097/sla.0000000000005788] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate whether robotic for middle or low rectal cancer produces an improvement in surgical outcomes compared with laparoscopic surgery in a randomized controlled trial (RCT). BACKGROUND There is a lack of proven clinical benefit of robotic total mesorectal excision (TME) compared with a laparoscopic approach in the setting of multicenter RCTs. METHODS Between July 2011 and February 2016, patients diagnosed with an adenocarcinoma located <10 cm from the anal verge and clinically rated T1-4aNxM0 were enrolled. The primary outcome was the completeness of TME assessed by a surgeon and a pathologist. RESULTS The RCT was terminated prematurely because of poor accrual of data. In all, 295 patients were assigned randomly to a robot-assisted TME group (151 in R-TME) or a laparoscopy-assisted TME group (144 in L-TME). The rates of complete TME were not different between groups (80.7% in R-TME, 77.1% in L-TME). Pathologic outcomes including the circumferential resection margin and the numbers of retrieved lymph nodes were not different between groups. In a subanalysis, the positive circumferential resection margin rate was lower in the R-TME group (0% vs 6.1% for L-TME; P =0.031). Among the recovery parameters, the length of opioid use was shorter in the R-TME group ( P =0.028). There was no difference in the postoperative complication rate between the groups (12.0% for R-TME vs 8.3% for L-TME). CONCLUSIONS In patients with middle or low rectal cancer, robotic-assisted surgery did not significantly improve the TME quality compared with conventional laparoscopic surgery (ClinicalTrial.gov ID: NCT01042743).
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Affiliation(s)
- Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Min Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ho Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seon Hahn Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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23
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Siragusa L, Pellino G, Sensi B, Panis Y, Bellato V, Khan J, Sica GS. Ambulatory laparoscopic colectomies: a systematic review. Colorectal Dis 2023; 25:1102-1115. [PMID: 36790358 DOI: 10.1111/codi.16511] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIM Ambulatory laparoscopic colectomy (ALC), meaning discharge within 24 h of surgical colonic resection, has recently been proposed in a few, selected patients. This systematic review was performed with the aim of reviewing protocols for ALC and assessing feasibility, safety and outcomes after ALC. METHOD A PRISMA-compliant systematic review and pooled analysis was performed searching all English studies published until October 2022 in PubMed, Cochrane Library, Web of Science (PROSPERO, CRD42022334463). Inclusion criteria were original articles including patients undergoing ALC, specifying at least one outcome of interest. Exclusion criteria were articles reporting a robotic-assisted procedure; unable to retrieve patient data from articles; the same patient series included in different studies. Primary outcomes were success, overall complications and readmission rates. Secondary outcomes included mortality and specific complications such us surgical site infection, anastomotic leak, ileus, bleeding, rate of ALC acceptance, and unscheduled consultation and reoperation rate. RESULTS Among 1087 studies imported for screening, 11 were included (1296 patients). The success rate was 47% with an overall morbidity of 14%. Readmission and reoperation rates were 5% and 1%, respectively. No mortality was recorded. Protocols of ALC differ significantly among published studies. CONCLUSIONS Overall, ALC appears to be safe and feasible in selected cases with an acceptable success rate and a low risk of readmission after hospital discharge. Future studies should evaluate patients' benefits and discharge criteria, as well as uniformity and standardization of eligibility criteria. This systematic review may help inform on ALC adoption in clinical practice.
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Affiliation(s)
- Leandro Siragusa
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
- Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Bruno Sensi
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly sur Seine, France
| | - Vittoria Bellato
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Jim Khan
- Colorectal Surgery, Portsmouth Hospitals University NHS Trust, University of Portsmouth, Portsmouth, UK
| | - Giuseppe S Sica
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
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Knitter S, Feldbrügge L, Nevermann N, Globke B, Galindo SAO, Winklmann T, Krenzien F, Haber PK, Malinka T, Lurje G, Schöning W, Pratschke J, Schmelzle M. Robotic versus laparoscopic versus open major hepatectomy - an analysis of costs and postoperative outcomes in a single-center setting. Langenbecks Arch Surg 2023; 408:214. [PMID: 37247050 PMCID: PMC10226911 DOI: 10.1007/s00423-023-02953-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE In the era of minimal-invasive surgery, the introduction of robotic liver surgery (RS) was accompanied by concerns about the increased financial expenses of the robotic technique in comparison to the established laparoscopic (LS) and conventional open surgery (OS). Therefore, we aimed to evaluate the cost-effectiveness of RS, LS and OS for major hepatectomies in this study. METHODS We analyzed financial and clinical data on patients who underwent major liver resection for benign and malign lesions from 2017 to 2019 at our department. Patients were grouped according to the technical approach in RS, LS, and OS. For better comparability, only cases stratified to the Diagnosis Related Groups (DRG) H01A and H01B were included in this study. Financial expenses were compared between RS, LS, and OS. A binary logistic regression model was used to identify parameters associated with increased costs. RESULTS RS, LS and OS accounted for median daily costs of 1,725 €, 1,633 € and 1,205 €, respectively (p < 0.0001). Median daily (p = 0.420) and total costs (16,648 € vs. 14,578 €, p = 0.076) were comparable between RS and LS. Increased financial expenses for RS were mainly caused by intraoperative costs (7,592 €, p < 0.0001). Length of procedure (hazard ratio [HR] = 5.4, 95% confidence interval [CI] = 1.7-16.9, p = 0.004), length of stay (HR [95% CI] = 8.8 [1.9-41.6], p = 0.006) and development of major complications (HR [95% CI] = 2.9 [1.7-5.1], p < 0.0001) were independently associated with higher costs. CONCLUSIONS From an economic perspective, RS may be considered a valid alternative to LS for major liver resections.
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Affiliation(s)
- Sebastian Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Linda Feldbrügge
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nora Nevermann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Brigitta Globke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Santiago Andres Ortiz Galindo
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Winklmann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp K Haber
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Malinka
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Vilsan J, Maddineni SA, Ahsan N, Mathew M, Chilakuri N, Yadav N, Munoz EJ, Nadeem MA, Abbas K, Razzaq W, Abdin ZU, Ahmed M. Open, Laparoscopic, and Robotic Approaches to Treat Colorectal Cancer: A Comprehensive Review of Literature. Cureus 2023; 15:e38956. [PMID: 37313091 PMCID: PMC10259746 DOI: 10.7759/cureus.38956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Surgery is usually required to treat colorectal cancer (CRC). Medical technology has advanced, providing various approaches to tackle this disease. Different surgeries are available, such as laparoscopic surgery, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and robotic surgery. Laparoscopic surgery has several benefits including reduced blood loss and shorter recovery time. It can also improve lung function and minimize complications. However, it requires more time to perform and has a higher risk of complications during the procedure. Robotic surgery provides a three-dimensional view of the surgical area allowing for greater precision in rectal surgeries and access to difficult-to-reach pelvic regions. This method utilizes robotics technology which reduces surgical time and speeds up recovery for patients. There are various surgical options available for treating CRC; however, laparoscopic surgery and robotic surgery offer unique advantages despite their own drawbacks. As technology continues to evolve, medical techniques will continue improving existing methods while providing new options resulting in better outcomes for patients. Compared to laparoscopy, robotic surgery has a lower rate of operative conversions and a shorter learning curve. However, it also has some drawbacks, such as a longer docking time, lack of tactile sensation, and higher cost. Therefore, the choice of surgical method should depend on patient characteristics, surgeon preference and expertise, and available resources. Currently, specialized centers offer robotic surgeries which are more expensive and take longer compared to open and laparoscopic approaches. Nonetheless, they are considered safe and feasible when compared to traditional surgery. Short-term outcomes for robotic surgeries are better, while long-term postoperative complication rates remain similar. However, there is a need for additional well-defined randomized control trials conducted across multiple centers to validate the use of robotic surgery over open and laparoscopic approaches. Improving patient care and outcomes is the objective of this comprehensive literature overview on surgical approaches for CRC.
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Affiliation(s)
- Jessica Vilsan
- Surgery, Dr Bhausaheb Sardesai Talegaon Rural Hospital, Pune, IND
| | - Sai Aditya Maddineni
- Surgery, Avalon University School of Medicine, Willemstad, CUW
- Surgery, UChicago Medicine AdventHealth GlenOaks, Glen Oaks, USA
| | - Nayab Ahsan
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Midhun Mathew
- Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
| | | | - Nilay Yadav
- General Physician, Rama Medical College, Kanpur, IND
| | | | | | - Kiran Abbas
- Community Health Sciences, Aga Khan University, Karachi, PAK
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Medicine, District Headquarter Hospital, Faisalabad, PAK
| | - Moiz Ahmed
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
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26
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Xue Y, Li S, Guo S, Kuang Y, Ke M, Liu X, Gong F, Li P, Jia B. Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer. BMC Geriatr 2023; 23:105. [PMID: 36803225 PMCID: PMC9942364 DOI: 10.1186/s12877-023-03822-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The incidence of colorectal cancer increases with aging. Curative-intent surgery based on a minimally invasive concept is expected to bring survival benefits to elderly patients (aged over 80 years) with colorectal cancer who are frequently with fragile health status and advanced tumors. The study explored survival outcomes in this patient population who received robotic or laparoscopic surgery and aimed to identify an optimal surgical option for those patients. METHODS We retrieved the clinical materials and follow-up data on elderly patients with colorectal carcinoma who received robotic or laparoscopic surgery in our institution. The pathological and surgical outcomes were compared to examine the efficacy and safety of the two approaches. The DFS (disease-free survival) and OS (overall survival) results at 3 years after surgery were assessed to explore the survival benefits. RESULTS A total of 111 patients were screened for the study, including 55 in the robotic group and 56 in the laparoscopic group. The demographic details were generally similar between the two groups. No statistically significant difference in the number of removed lymph nodes was observed between the two approaches, with a median of 15 versus 14 (P = 0.053). The intraoperative blood loss was significantly reduced by robotic technique when compared to the laparoscopic approach, with a mean of 76.9 ml versus 161.6 ml (P = 0.025). There were no significant differences in operation time, conversion, postoperative complications and recovery, and long-term outcomes between the two groups. CONCLUSION Robotic surgery was prized for elderly patients with colorectal cancer who developed anemia and/or hematological conditions.
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Affiliation(s)
- Yonggan Xue
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Sen Li
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Shaohua Guo
- grid.414252.40000 0004 1761 8894Department of General Surgery, The Eighth Medical Center, Chinese PLA General Hospital, Haidian District, No.Jia17, Heishanhu Road, Beijing, 100089 China
| | - Yanshen Kuang
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Mu Ke
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Xin Liu
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Fangming Gong
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Peng Li
- grid.414252.40000 0004 1761 8894Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853 China
| | - Baoqing Jia
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Haidian District, No.28, Fuxing Road, Beijing, 100853, China.
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Patient experiences of left-sided colorectal resection by robotic, conventional laparoscopic and open approaches: a qualitative study. Tech Coloproctol 2023:10.1007/s10151-023-02764-8. [PMID: 36790541 DOI: 10.1007/s10151-023-02764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Robotic surgery (RS) is increasingly employed in colorectal surgical practice, widening the range of surgical techniques offered to patients. We investigated the perceptions of patients with colorectal cancer in relation to RS, open surgery (OS) and conventional laparoscopic surgery (CLS), to identify ideas or assumptions which, in the context of shared surgeon-patient decision-making, may affect the resultant choice of surgical technique. We also investigated salient factors affecting patients' perioperative experience, including those of RS patients, to guide improvements in care and preoperative patient preparation. METHODS This study was conducted on patients who underwent resection of left-sided colorectal cancer at a large UK teaching hospital from November 2020 to July 2021. Purposive sampling was used to ensure a roughly equal proportion of patients who underwent RS, CLS and OS. The patients included in the study participated in semi-structured interviews six weeks postoperatively. The interview schedule allowed discussion around patients' experience of their surgery and postoperative recovery, and their perceptions of surgical techniques. Interview transcripts were coded manually using inductive thematic analysis, and analyst triangulation was employed to refine coding schemes and ensure reliability of emerging themes. RESULTS Twenty-seven patients were recruited to the study; RS n = 9 (median age 69 [range 60-80] years); CLS n = 10 (median age 72 [range 32-82] years; OS n = 8 (median age 71 [range 60-75] years). Patients understood the technological benefits of RS but were concerned by a risk of technological failure causing patient harm. OS was understood to be associated with more pain and longer recovery than RS or CLS. Patients perceived CLS to be more technically challenging compared with OS. Less pain and smaller wounds than expected were significant positive factors in the experience of RS and CLS patients specifically. Complications and emotional impact were significant factors in the experience of all groups, for which many patients felt underprepared. CONCLUSIONS Patients generally have a positive view of RS and technical innovation in surgery. Concerns mostly centred around failure of technology. Many patients felt unprepared for significant factors in their perioperative experience. Surgeons and healthcare providers should be prepared to address patients' perceptions and expectations of colorectal surgery preoperatively.
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Comparison of robotic vs laparoscopic left-sided colorectal cancer resections. J Robot Surg 2023; 17:205-213. [PMID: 35610541 PMCID: PMC9129896 DOI: 10.1007/s11701-022-01414-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
Robotic assisted surgery (RAS) has become increasingly adopted in colorectal cancer surgery. This study aims to compare robotic and laparoscopic approaches to left sided colorectal resections in terms of surgical outcomeswith no formal enhanced recovery programme. All patients undergoing robotic or laparoscopic left sided or rectal (high and low anterior resection) cancer surgery at a single tertiary referral centre over 3 years were included.A total of 184 consecutive patients from July 2017 to December 2020 were included in this study, with 40.2% (n=74/184) undergoing RAS. The median age at time of surgery was 68 years (IQR 60-73 years). RAS had a significantly shorter length of median stay of 3 days, compared to 5 days in the conventional laparoscopic surgery (CLS) group (p<0.001). RAS had a significantly lower rate of conversion to open surgery (0% vs 16.4%, p<0.001). The median operative time was also shorter in RAS (308 minutes), compared to CLS (326 minutes, p=0.019). The overall rate of any complication was 16.8%, with the RAS experiencing a lower complication rate (12.2% vs 20.0%, p=0.041). There was no significant difference in anastomotic leak rates between the two groups (4.0% vs 5.5%, p=0.673), or in terms of complete resection (R0) (robotic 98.6%, laparoscopic 100%, p=0.095). Robotic left sided colorectal surgery delivers equivalent oncological resection compared to laparoscopic approaches, with the added benefits of reduced length of stay and lower rates of conversion to open surgery. This has both clinical and healthcare economic benefits.
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Qiu Y, Li Y, Chen Z, Chai N, Liang X, Zhang D, Wei Z. Application of the advance incision in robotic-assisted laparoscopic rectal anterior resection. Front Surg 2023; 10:1141672. [PMID: 36960211 PMCID: PMC10028139 DOI: 10.3389/fsurg.2023.1141672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
Background The incidence of rectal cancer is increasing each year. Robotic surgery is being used more frequently in the surgical treatment of rectal cancer; however, several problems associated with robotic surgery persist, such as docking the robot repeatedly to perform auxiliary incisions and difficulty exposing the operative field of obese patients. Herein we introduce a new technology that effectively improves the operability and convenience of robotic rectal surgery. Objectives To simplify the surgical procedure, enhance operability, and improve healing of the surgical incision, we developed an advance incision (AI) technique for robotic-assisted laparoscopic rectal anterior resection, and compared its safety and feasibility with those of intraoperative incision. Methods Between January 2016 and October 2021, 102 patients with rectal cancer underwent robotic-assisted laparoscopic rectal anterior resection with an AI or intraoperative incision (iOI) incisions. We compared the perioperative, incisional, and oncologic outcomes between groups. Results No significant differences in the operating time, blood loss, time to first passage of flatus, time to first passage of stool, duration of hospitalization, and rate of overall postoperative complications were observed between groups. The mean time to perform auxiliary incisions was shorter in the AI group than in the iOI group (14.14 vs. 19.77 min; p < 0.05). The average incision length was shorter in the AI group than in the iOI group (6.12 vs. 7.29 cm; p < 0.05). Postoperative incision pain (visual analogue scale) was lower in the AI group than in the iOI group (2.5 vs. 2.9 p = 0.048). No significant differences in incision infection, incision hematoma, incision healing time, and long-term incision complications, including incision hernia and intestinal obstruction, were observed between groups. The recurrence (AI group vs. iOI group = 4.0% vs. 5.77%) and metastasis rates (AI group vs. iOI group = 6.0% vs. 5.77%) of cancer were similar between groups. Conclusion The advance incision is a safe and effective technique for robotic-assisted laparoscopic rectal anterior resection, which simplifies the surgical procedure, enhances operability, and improves healing of the surgical incision.
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Affiliation(s)
- Yuhao Qiu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Li
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenzhou Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ninghui Chai
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xianping Liang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dahong Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Zhengqiang Wei
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Huang Z, Li T, Zhang G, Zhou Z, Shi H, Tang C, Yang L, Lei X. Comparison of open, laparoscopic, and robotic left colectomy for radical treatment of colon cancer: a retrospective analysis in a consecutive series of 211 patients. World J Surg Oncol 2022; 20:345. [PMID: 36253768 PMCID: PMC9578184 DOI: 10.1186/s12957-022-02796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Robotic surgery has been widely used in the radical treatment of colonic cancer. However, it is unclear what advantages the robotic approach offers over other approaches in left colectomy. This study aims to explore the advantage of robotic surgery in left colectomy by comparing open, laparoscopic, and robotic surgery. Methods A retrospective analysis was performed on the clinical data of patients with radical left colectomy for colon cancer who were admitted to the Department of General Surgery, The First Affiliated Hospital of Nanchang University, from November 2012 to November 2017. Two hundred eleven patients included were divided into the open surgery group (OS, n=49), laparoscopic surgery group (LS, n=92), and robotic surgery group (RS, n=70) according to surgical techniques. The clinicopathologic data were collected for clinical outcome assessment. Finally, the clinical value of RS in radical left colectomy was further evaluated by propensity score matching (PSM) analysis. Results Three groups were similar in demographics and clinical characteristics. Compared with OS, LS and RS groups had better intraoperative and perioperative clinical outcomes. Moreover, the RS group exhibited the minimum operative times, length of stay (LOS), and evaluated blood loss. LS and RS also exhibited less perioperative and postoperative long-term complications. Three groups showed similar postoperative pathological outcomes. The overall survival and disease-free survival were also similar among the three groups (all P > 0.05). Cox regression analysis showed surgical approach was not a prognostic factor for overall survival (P = 0.671) and disease-free survival (P = 0.776). PSM analysis of RS and LS by clinical characteristics showed RS showed shorter operation time (P < 0.001) and LOS for patients without complications (P = 0.005). However, no significant differences were found in perioperative and long-term postoperative complications, pathological outcomes, overall survival, and disease-free survival. Conclusions Among three techniques for radical left colectomy, LS and RS had significant advantages over OS in short-term clinical outcomes, and no significant differences were found in overall, disease-free survival, local recurrence, and distant metastasis incidence. Moreover, RS shows better perioperative clinical outcomes but without compromising survival compared with LS. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02796-8.
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Affiliation(s)
- Zhixiang Huang
- Gastrointernal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China.,China-Japan Union Hospital Of Jilin University, 130000, Chang Chun, China
| | - Taiyuan Li
- Gastrointernal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China.,Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Genghua Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhen Zhou
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Haoran Shi
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Cheng Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Lingling Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiong Lei
- Gastrointernal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China. .,Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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Wang L, Yu Y, Wang J, Li S, Jiang T. Evaluation of the learning curve for robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy. Front Surg 2022; 9:969418. [PMID: 35937606 PMCID: PMC9354576 DOI: 10.3389/fsurg.2022.969418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background The robotic surgical system is being used in various bariatric procedures. However, only a few studies with very small sample size are present on robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy (SADI-S). Moreover, to date, the learning curve of robotic SADI-S has been poorly evaluated yet. Objective This retrospective study aimed to estimate the learning curve of robotic SADI-S. Methods 102 consecutive patients who underwent robotic SADI-S between March 2020 and December 2021 were included. Textbook outcome standard was performed to comprehensively evaluate clinical outcome of robotic SADI-S. Based on the textbook outcome, we evaluated the learning curve of robotic SADI-S by the cumulative sum (CUSUM) method. Results The mean operative time was 186.13 ± 36.91 min. No conversion to laparotomy or deaths occurred during the study period. The rate of complications was 6.9% (n = 7), of which major complications were identified in 2.9% (n = 3), including 2 gastric leakages and 1 respiratory failure. A total of 60 patients reached the textbook outcome standard. The rate of textbook outcome was positive and was steadily increasing after the number of surgical cases accumulated to the 58th case. Taking the 58th case as the boundary, all the patients were divided into the learning stage group (the first 58 patients) and mastery stage group (the last 44 patients). The rate of complications, proportion of abdominal drainage tubes and postoperative hospital stay were significantly higher in the learning stage group compared with the mastery stage group (P < 0.05). No significant difference was observed between the two groups in terms of patient demographic data, operative times, reoperations and readmission. Conclusion Robotic SADI-S is a feasible and reproducible surgical technique with a learning curve of 58 cases.
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Huang P, Li S, Li P, Jia B. The Learning Curve of Da Vinci Robot-Assisted Hemicolectomy for Colon Cancer: A Retrospective Study of 76 Cases at a Single Center. Front Surg 2022; 9:897103. [PMID: 35846959 PMCID: PMC9276975 DOI: 10.3389/fsurg.2022.897103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Robotic-assisted right hemicolectomy (RARH) has many benefits in treating colon cancer, but it is a new technology that needs to be evaluated. This study aims to assess the learning curve (LC) of RARH procedures with the complete mesoscopic exception and D3 lymph node dissection for colon carcinoma. Methods A retrospective analysis was performed on a consecutive series of 76 patients who underwent RARH from July 2014 to March 2018. The operation time was evaluated using the cumulative sum (CUSUM) method to analyze the LC. The patients were categorized into two groups based on the LC: Phase I and Phase II. Statistical methods were used to compare clinicopathological data on intraoperative and perioperative outcomes at different stages of the study. Results The peak point of the LC was observed in the 27th case. Using the CUSUM method, we divide the LC into two stages. Stage 1 (initial learning stage): Cases 1–27 and Stage 2 (proficiency phase): Cases 28–76. There were no obvious distinctions between the two patients’ essential characteristics (age, sex, body mass index, clinical stage, and ASA score). The mean operation time of each group is 187.37 ± 45.56 min and 161.1 ± 37.74 min (P = 0.009), respectively. The intraoperative blood loss of each group is 170.4 ± 217.2 ml and 95.7 ± 72.8 ml (P = 0.031), respectively. Conclusion Based on the LC with CUSUM analysis, the data suggest that the learning phase of RARH was achieved after 27 cases. The operation time and the intraoperative blood loss decrease with more cases performed.
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Affiliation(s)
- Pu Huang
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Sen Li
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Peng Li
- Department of General Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Baoqing Jia
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
- Correspondence: Baoqing Jia
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Reinisch A, Liese J, Padberg W, Ulrich F. Robotic operations in urgent general surgery: a systematic review. J Robot Surg 2022; 17:275-290. [PMID: 35727485 PMCID: PMC10076409 DOI: 10.1007/s11701-022-01425-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/06/2022] [Indexed: 12/07/2022]
Abstract
Robotically assisted operations are the state of the art in laparoscopic general surgery. They are established predominantly for elective operations. Since laparoscopy is widely used in urgent general surgery, the significance of robotic assistance in urgent operations is of interest. Currently, there are few data on robotic-assisted operations in urgent surgery. The aim of this study was to collect and classify the existing studies. A two-stage, PRISMA-compliant literature search of PubMed and the Cochrane Library was conducted. We analyzed all articles on robotic surgery associated with urgent general surgery resp. acute surgical diseases of the abdomen. Gynecological and urological diseases so as vascular surgery, except mesenterial ischemia, were excluded. Studies and case reports/series published between 1980 and 2021 were eligible for inclusion. In addition to a descriptive synopsis, various outcome parameters were systematically recorded. Fifty-two studies of operations for acute appendicitis and cholecystitis, hernias and acute conditions of the gastrointestinal tract were included. The level of evidence is low. Surgical robots in the narrow sense and robotic camera mounts were used. All narrow-sense robots are nonautonomous systems; in 82%, the Da Vinci® system was used. The most frequently published emergency operations were urgent cholecystectomies (30 studies, 703 patients) followed by incarcerated hernias (9 studies, 199 patients). Feasibility of robotic operations was demonstrated for all indications. Neither robotic-specific problems nor extensive complication rates were reported. Various urgent operations in general surgery can be performed robotically without increased risk. The available data do not allow a final evidence-based assessment.
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Affiliation(s)
- Alexander Reinisch
- Department of General, Visceral and Oncologic Surgery, Wetzlar Hospital and Clinics, Forsthausstr. 1, 35578, Wetzlar, Germany.
| | - Juliane Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital Giessen, Giessen, Germany
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital Giessen, Giessen, Germany
| | - Frank Ulrich
- Department of General, Visceral and Oncologic Surgery, Wetzlar Hospital and Clinics, Forsthausstr. 1, 35578, Wetzlar, Germany
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Hahn SJ, Sylla P. Technological Advances in the Surgical Treatment of Colorectal Cancer. Surg Oncol Clin N Am 2022; 31:183-218. [DOI: 10.1016/j.soc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Huang ZX, Zhou Z, Shi HR, Li TY, Ye SP. Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center. World J Gastrointest Surg 2021; 13:1660-1672. [PMID: 35070071 PMCID: PMC8727186 DOI: 10.4240/wjgs.v13.i12.1660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/16/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient.
AIM To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.
METHODS In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated.
RESULTS Among 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection (P < 0.001) and level III American Society of Anesthesiologists (ASA) score (P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection (P < 0.001) and comorbidities (P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were independent risk factors. Multiple organ resection (P < 0.001) and level III ASA score (P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery.
CONCLUSION Multiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.
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Affiliation(s)
- Zhi-Xiang Huang
- General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhen Zhou
- The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hao-Ran Shi
- The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Yuan Li
- General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Shan-Ping Ye
- General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Gillespie BM, Gillespie J, Boorman RJ, Granqvist K, Stranne J, Erichsen-Andersson A. The Impact of Robotic-Assisted Surgery on Team Performance: A Systematic Mixed Studies Review. HUMAN FACTORS 2021; 63:1352-1379. [PMID: 32613863 DOI: 10.1177/0018720820928624] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to describe the impact of robotic-assisted surgery on team performance in the operating room. BACKGROUND The introduction of surgical robots has improved the technical performance of surgical procedures but has also contributed to unexpected interactions in surgical teams, leading to new types of errors. METHOD A systematic literature search of Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Cochrane, Web of Science, PsycINFO, and Scopus databases using key words and MeSH terms was conducted. Screening identified studies employing qualitative and quantitative methods published between January 2000 and September 2019. Two reviewers independently appraised the methodological quality of the articles using the Mixed Methods Appraisal Tool (2018). Discussions were held among authors to examine quality scores of the studies and emergent themes, and agreement was reached through consensus. Themes were derived using inductive content analysis. RESULTS Combined searches identified 1,065 citations. Of these, 19 articles, 16 quantitative and 3 qualitative, were included. Robotic-assisted surgeries included urology, gynecology, cardiac, and general procedures involving surgeons, anesthetists, nurses, and technicians. Three themes emerged: Negotiating the altered physical environs and adapting team communications to manage task and technology; managing the robotic system to optimize workflow efficiency; and technical proficiency depends on experience, team familiarity, and case complexity. CONCLUSION Inclusion of a robot as a team member adds further complexity to the work of surgery. APPLICATION These review findings will inform training programs specifically designed to optimize teamwork, workflow efficiency, and learning needs.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery & Menzies Institute of Health, Brisbane, QLD, Australia
- Gold Coast Hospital and Health Service, QLD, Australia
| | | | - Rhonda J Boorman
- School of Nursing & Midwifery & Menzies Institute of Health, Brisbane, QLD, Australia
| | - Karin Granqvist
- 3570Sahlgrenska Academy, Institute of Health & Caring Sciences, University of Gothenburg, Sweden
| | - Johan Stranne
- Sahlgrenska University Hospital, Gothenburg, Sweden
- 3570University of Gothenburg, Sweden
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Cuk P, Kjær MD, Mogensen CB, Nielsen MF, Pedersen AK, Ellebæk MB. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc 2021; 36:32-46. [PMID: 34724576 PMCID: PMC8741661 DOI: 10.1007/s00464-021-08782-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022]
Abstract
Background Robot-assisted surgery is increasingly adopted in colorectal surgery. However, evidence for the implementation of robot-assisted surgery for colon cancer is sparse. This study aims to evaluate the short-term outcomes of robot-assisted colon surgery (RCS) for cancer compared to laparoscopic colon surgery (LCS). Methods Embase, MEDLINE, and Cochrane Library were searched between January 1, 2005 and October 2, 2020. Randomized clinical trials and observational studies were included. Non-original literature was excluded. Primary endpoints were anastomotic leakage rate, conversion to open surgery, operative time, and length of hospital stay. Secondary endpoints were surgical efficacy and postoperative morbidity. We evaluated risk of bias using RoB2 and ROBINS-I quality assessment tools. We performed a pooled analysis of primary and secondary endpoints. Heterogeneity was assessed by I2, and possible causes were explored by sensitivity- and meta-regression analyses. Publication bias was evaluated by Funnel plots and Eggers linear regression test. The level of evidence was assessed by GRADE. Results Twenty studies enrolling 13,799 patients (RCS 1740 (12.6%) and LCS 12,059 (87.4%) were included in the meta-analysis that demonstrated RCS was superior regarding: anastomotic leakage (odds ratio (OR) = 0.54, 95% CI [0.32, 0.94]), conversion (OR = 0.31, 95% CI [0.23, 0.41]), overall complication rate (OR = 0.85, 95% CI [0.73, 1.00]) and time to regular diet (MD = − 0.29, 95% CI [− 0.56, 0.02]). LCS proved to have a shortened operative time compared to RCS (MD = 42.99, 95% CI [28.37, 57.60]). Level of evidence was very low according to GRADE. Conclusion RCS showed advantages in colonic cancer surgery regarding surgical efficacy and morbidity compared to LCS despite a predominant inclusion of non-RCT with serious risk of bias assessment and a very low level of evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08782-7.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, University Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mie Dilling Kjær
- Research Unit for Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Michael Festersen Nielsen
- Surgical Department, University Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Cuk P, Pedersen AK, Lambertsen KL, Mogensen CB, Nielsen MF, Helligsø P, Gögenur I, Ellebæk MB. Systemic inflammatory response in robot-assisted and laparoscopic surgery for colon cancer (SIRIRALS): study protocol of a randomized controlled trial. BMC Surg 2021; 21:363. [PMID: 34635066 PMCID: PMC8507379 DOI: 10.1186/s12893-021-01355-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Background Robot-assisted surgery is being increasingly adopted in treating colorectal cancer, and the transition from laparoscopic surgery to robot-assisted surgery is a trend. The evidence of the benefits of robot-assisted surgery is sparse. However, findings are associated with improved patient-related outcomes and overall morbidity rates compared to laparoscopic surgery. This induction is unclear, considering both surgical modalities are characterized as minimally invasive. This study aims to evaluate the systemic and peritoneal inflammatory stress response induced by robot-assisted surgery compared with laparoscopic surgery for elective colon cancer resections in a prospective, randomized controlled clinical trial. Methods This study is a single-centre randomized controlled superiority trial with 50 colon cancer participants. The primary endpoint is the level of systemic inflammatory response expressed as serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels between postoperative days one and three. Secondary endpoints include (i) levels of systemic inflammation in serum expressed by a panel of inflammatory and pro-inflammatory cytokines measured during the first three postoperative days, (ii) postoperative surgical and medical complications (30 days) according to Clavien-Dindo classification and Comprehensive Complication Index, (iii) intraoperative blood loss, (iv) conversion rate to open surgery, (v) length of surgery, (vi) operative time, (vii) the number of harvested lymph nodes, and (viii) length of hospital stay. The exploratory endpoints are (i) levels of peritoneal inflammatory response in peritoneal fluid expressed by inflammatory and pro-inflammatory cytokines between postoperative day one and three, (ii) patient-reported health-related quality of recovery-15 (QoR-15), (iii) 30 days mortality rate, (iv) heart rate variability and (v) gene transcript (mRNA) analysis. Discussion To our knowledge, this is the first clinical randomized controlled trial to clarify the inflammatory stress response induced by robot-assisted or laparoscopic surgery for colon cancer resections. Trial registration This trial is registered at Clinicaltrials.gov (Identifier: NCT04687384) on December, 29, 2020, Regional committee on health research ethics, Region of Southern Denmark (N75709) and Data Protection Agency, Hospital Sønderjylland, University Hospital of Southern Denmark (N20/46179). Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01355-4.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | | | - Kate Lykke Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Michael Festersen Nielsen
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Ismail Gögenur
- Surgical Department, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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Valadão M, Cesar D, Véo CAR, Araújo RO, do Espirito Santo GF, Oliveira de Souza R, Aguiar S, Ribeiro R, de Castro Ribeiro HS, de Souza Fernandes PH, Oliveira AF. Brazilian society of surgical oncology: Guidelines for the surgical treatment of mid-low rectal cancer. J Surg Oncol 2021; 125:194-216. [PMID: 34585390 DOI: 10.1002/jso.26676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third leading cause of cancer in North America, Western Europe, and Brazil, and represents an important public health problem. It is estimated that approximately 30% of all the CRC cases correspond to tumors located in the rectum, requiring complex multidisciplinary treatment. In an effort to provide surgeons who treat rectal cancer with the most current information based on the best evidence in the literature, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guidelines for rectal cancer treatment that is focused on the main topics related to daily clinical practice. OBJECTIVES The SBCO developed the present guidelines to provide recommendations on the main topics related to the treatment of mid-low rectal cancer based on current scientific evidence. METHODS Between May and June 2021, 11 experts in CRC surgery met to develop the guidelines for the treatment of mid-low rectal cancer. A total of 22 relevant topics were disseminated among the participants. The methodological quality of a final list with 221 sources was evaluated, all the evidence was examined and revised, and the treatment guideline was formulated by the 11-expert committee. To reach a final consensus, all the topics were reviewed via a videoconference meeting that was attended by all 11 of the experts. RESULTS The prepared guidelines contained 22 topics considered to be highly relevant in the treatment of mid-low rectal cancer, covering subjects related to the tests required for staging, surgical technique-related aspects, recommended measures to reduce surgical complications, neoadjuvant strategies, and nonoperative treatments. In addition, a checklist was proposed to summarize the important information and offer an updated tool to assist surgeons who treat rectal cancer provide the best care to their patients. CONCLUSION These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the treatment of mid-low rectal cancer and are a practical guide that can help surgeons who treat rectal cancer make the best therapeutic decision.
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Affiliation(s)
- Marcus Valadão
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Daniel Cesar
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | - Rodrigo Otávio Araújo
- Division of Abdominal-Pelvic Surgery, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | | | - Samuel Aguiar
- Department of Surgical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Reitan Ribeiro
- Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
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Liu C, Li X, Wang Q. Postoperative complications observed with robotic versus laparoscopic surgery for the treatment of rectal cancer: An updated meta-analysis of recently published studies. Medicine (Baltimore) 2021; 100:e27158. [PMID: 34516507 PMCID: PMC8428752 DOI: 10.1097/md.0000000000027158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This is an updated meta-analysis comparing the postoperative complications observed with robotic versus laparoscopic surgery (LS) for the treatment of rectal cancer. METHODS Cochrane central, MEDLNE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), Google Scholar, Web of Science and http://www.ClinicalTrials.gov were searched for studies (published after the year 2015), comparing robotic versus LS for the treatment of rectal cancer. The postoperative outcomes were considered as the endpoints in this analysis. RevMan 5.4 was used to carry out the statistical analysis. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the results following data analysis. RESULTS A total number of 22,744 participants were included in this study whereby 9178 participants were assigned to the robotic surgery and 13,566 participants were assigned to the LS group. The time period of patients' enrollment varied from years 2007 to 2017. Our results showed that overall complications (RR: 0.91, 95% CI: 0.71-1.17; P = .45), wound complications (RR: 0.81, 95% CI: 0.64-1.04; P = .09), anastomotic leak (RR: 1.12, 95% CI: 0.88-1.42; P = .37), anastomotic bleeding (RR: 0.88, 95% CI: 0.29-2.64; P = .82), stoma-related complications (RR: 0.88, 95% CI: 0.24-3.21; P = .85), intra-abdominal abscess (RR: 0.53. 95% CI: 0.22-1.31; P = .17), urinary tract infection (RR: 0.94, 95% CI: 0.53-1.66; P = .83), enterocolitis (RR: 1.35, 95% CI: 0.38-4.71; P = .64), reoperation (RR: 0.85, 95% CI: 0.46-1.54; P = .58), and mortality (RR: 0.75, 95% CI: 0.34-1.62; P = .46) were not significantly different between robotic-assisted versus LS for rectal cancer. Postoperative ileus (RR: 1.21, 95% CI: 0.81-1.81; P = .34), readmission (RR: 1.17, 95% CI: 0.75-1.83; P = .48), and urinary retention (RR: 0.51, 95% CI: 0.21-1.23; P = .14) were also similarly manifested. CONCLUSIONS In this updated meta-analysis, both robotic and laparoscopic surgeries were equally effective for the treatment of rectal cancer. Similar postoperative complications were observed. However, our analysis was restricted only to postoperative outcomes, parameters such as duration of surgery were not taken into consideration.
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Affiliation(s)
- Chengkui Liu
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Zibo, Shandong, PR China
| | - Xiaoqing Li
- Operating Room, Zibo Central Hospital, Zibo, Shandong, PR China
| | - Qingfeng Wang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Zibo, Shandong, PR China
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Matsuyama T, Endo H, Yamamoto H, Takemasa I, Uehara K, Hanai T, Miyata H, Kimura T, Hasegawa H, Kakeji Y, Inomata M, Kitagawa Y, Kinugasa Y. Outcomes of robot-assisted versus conventional laparoscopic low anterior resection in patients with rectal cancer: propensity-matched analysis of the National Clinical Database in Japan. BJS Open 2021; 5:6374226. [PMID: 34553225 PMCID: PMC8458638 DOI: 10.1093/bjsopen/zrab083] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Robot-assisted laparoscopic surgery has several advantages over conventional laparoscopy. However, population-based comparative studies for low anterior resection are limited. This article aimed to compare peri-operative results of robot-assisted low anterior resection (RALAR) and laparoscopy. METHODS This retrospective cohort study used data from patients treated with RALAR or conventional laparoscopic low anterior resection (CLLAR) between October 2018 and December 2019, as recorded in the Japanese National Clinical Database, a data set registering clinical information, perioperative outcomes, and mortality. Of note, the registry does not include information on the tumour location (centimetres from the anal verge) and diverting stoma creation. Perioperative outcomes, including rate of conversion to open surgery, were compared between RALAR and CLLAR groups. Confounding factors were adjusted for using propensity score matching. RESULTS Of 21 415 patients treated during the study interval, 20 220 were reviewed. Two homogeneous groups of 2843 patients were created by propensity score matching. The conversion rate to open surgery was significantly lower in the RALAR group than in the CLLAR group (0.7 versus 2.0 per cent; P < 0.001). The RALAR group had a longer operating time (median: 352 versus 283 min; P < 0.001), less intraoperative blood loss (15 versus 20 ml; P < 0.001), a lower in-hospital mortality rate (0.1 versus 0.5 per cent; P = 0.007), and a shorter postoperative hospital stay (median: 13 versus 14 days; P < 0.001) compared with the CLLAR group. The CLLAR group had a lower rate of readmission within 30 days (2.4 versus 3.3 per cent; P = 0.045). CONCLUSION These data highlight the reduced conversion rate, in-hospital mortality rate, intraoperative blood loss, and length of postoperative hospital stay for rectal cancer surgery in patients treated using robot-assisted laparoscopic surgery compared with laparoscopic low anterior resection.
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Affiliation(s)
- T Matsuyama
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - H Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - I Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - K Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Hanai
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - H Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - T Kimura
- Project Management Subcommittee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - H Hasegawa
- Project Management Subcommittee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Y Kakeji
- Database Committee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - M Inomata
- Department of Gastroenterological and Paediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Y Kitagawa
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Y Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Tagliabue F, Burati M, Chiarelli M, Cioffi U, Zago M. Robotic surgery in colon cancer: current evidence and future perspectives – narrative review. Artif Intell Gastrointest Endosc 2021; 2:110-116. [DOI: 10.37126/aige.v2.i4.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/14/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
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Grosek J, Ales Kosir J, Sever P, Erculj V, Tomazic A. Robotic versus laparoscopic surgery for colorectal cancer: a case-control study. Radiol Oncol 2021; 55:433-438. [PMID: 34051705 PMCID: PMC8647796 DOI: 10.2478/raon-2021-0026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Robotic resections represent a novel approach to treatment of colorectal cancer. The aim of our study was to critically assess the implementation of robotic colorectal surgical program at our institution and to compare it to the established laparoscopically assisted surgery. PATIENTS AND METHODS A retrospective case-control study was designed to compare outcomes of consecutively operated patients who underwent elective laparoscopic or robotic colorectal resections at a tertiary academic centre from 2019 to 2020. The associations between patient characteristics, type of operation, operation duration, conversions, duration of hospitalization, complications and number of harvested lymph nodes were assessed by using univariate logistic regression analysis. RESULTS A total of 83 operations met inclusion criteria, 46 robotic and 37 laparoscopic resections, respectively. The groups were comparable regarding the patient and operative characteristics. The operative time was longer in the robotic group (p < 0.001), with fewer conversions to open surgery (p = 0.004), with less patients in need of transfusions (p = 0.004) and lower reoperation rate (p = 0.026). There was no significant difference between the length of stay (p = 0.17), the number of harvested lymph nodes (p = 0.24) and the overall complications (p = 0.58). CONCLUSIONS The short-term results of robotic colorectal resections were comparable to the laparoscopically assisted operations with fewer conversions to open surgery, fewer blood transfusions and lower reoperation rate in the robotic group.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, Ljubljana University Medical Center, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Jurij Ales Kosir
- Department of Abdominal Surgery, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Primoz Sever
- Department of Abdominal Surgery, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Vanja Erculj
- Faculty of Criminal Justice and Security, University of Maribor, Ljubljana, Slovenia
| | - Ales Tomazic
- Department of Abdominal Surgery, Ljubljana University Medical Center, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Cuk P, Simonsen RM, Komljen M, Nielsen MF, Helligsø P, Pedersen AK, Mogensen CB, Ellebæk MB. Improved perioperative outcomes and reduced inflammatory stress response in malignant robot-assisted colorectal resections: a retrospective cohort study of 298 patients. World J Surg Oncol 2021; 19:155. [PMID: 34022914 PMCID: PMC8141231 DOI: 10.1186/s12957-021-02263-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background Robot-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study’s main objective was to compare short-term complication rates, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robot-assisted. Methods We conducted a retrospective cohort study comparing the robot-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume center from May 2017 to March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response. Results Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robot-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4, 5) versus 5 days, interquartile range (4–7), p < 0.001), and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robot-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.23, 95% confidence interval (1.06–1.46), p = 0.008). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery, and surgical or medical short-term complication rates. Conclusion Robot-assisted surgery is feasible and can be safely implemented for colorectal resections. The robot-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short- and long-term outcomes of robotic surgery for colorectal cancer.
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Affiliation(s)
- Pedja Cuk
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark. .,Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | - Mirjana Komljen
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Michael Festersen Nielsen
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark.,Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Surgical Department, Odense University Hospital, Odense, Denmark
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Guerra F, Giuliani G, Coletta D. The risk of conversion in minimally invasive oncological abdominal surgery. Meta-analysis of randomized evidence comparing traditional laparoscopic versus robot-assisted techniques. Langenbecks Arch Surg 2021; 406:607-612. [PMID: 33743066 DOI: 10.1007/s00423-021-02106-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to investigate the risk of conversion associated with conventional laparoscopic surgery (LAP) versus robot-assisted surgery (ROB) in patients undergoing abdominal oncological surgery. Possible differences between ROB and LAP on postoperative overall and major morbidity, operative time, and length of hospitalization were also assessed. METHODS We included randomized controlled trials of LAP versus ROB surgery in patients with abdominal malignancy. We searched PubMed, EMBASE, and the Central registries through September 2020. Risk of bias was estimated concerning randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. RESULTS A total of 1867 patients from 12 trials were included in this review. The rate of conversion was significantly higher for LAP than for ROB patients (10 trials, 1447 participants, p = 0.03, OR = 0.56 [0.33, 0.95]). There was a nonsignificant advantage of ROB over LAP on the rate of overall postoperative morbidity (12 trials, 1867 participants, p = 0.32, OR = 0.83) and major morbidity (7 trials, 792 participants, p = 0.87, OR= 0.93). ROB was also associated with prolonged operative time and abbreviated postoperative hospitalization as compared to LAP (p = 0.002, MD = 27.87, and p = 0.04, MD = -0.57, respectively). CONCLUSIONS According to the available highest level of evidence, the application of ROB decreases the incidence of unplanned conversion into an open procedure as compared to standard LAP in the setting of oncological minimally invasive surgery.
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Affiliation(s)
- Francesco Guerra
- Ospedali Riuniti Marche Nord, Pesaro, Italy.
- Misericordia Hospital, Grosseto, Italy.
| | | | - Diego Coletta
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Desouza AL, Raj Kumar B, Sasi S, Malpangudi S, Saklani AP. Robotic total proctocolectomy with en masse total pelvic exenteration - a video vignette. Colorectal Dis 2021; 23:332. [PMID: 33098190 DOI: 10.1111/codi.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Ashwin L Desouza
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Barath Raj Kumar
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Sajith Sasi
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | | | - Avanish P Saklani
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
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Alawfi H, Kim HS, Yang SY, Kim NK. Robotics Total Mesorectal Excision Up To the Minute. Indian J Surg Oncol 2020; 11:552-564. [PMID: 33281399 PMCID: PMC7714834 DOI: 10.1007/s13193-020-01109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Abstract
Surgical techniques have evolved over the past few decades, and minimally invasive surgery has been rapidly adapted to become a preferred operative approach for treating colorectal diseases. However, many of the procedures remain a technical challenge for surgeons to perform laparoscopically, which has prompted the development of robotic platforms. Robotic surgery has been introduced as the latest advance in minimally invasive surgery. The present article provides an overview of robotic rectal surgery and describes many advances that have been made in the field over the past two decades. More specifically, the introduction of the robotic platform and its benefits, and the limitations of current robotic technology, are discussed. Although the main advantages of robotic surgery over conventional laparoscopy appear to be lower conversion rates and better surgical specimen quality, oncological and functional outcomes appear to be similar to those of other alternatives. Other potential benefits include earlier recovery of voiding and sexual function after robotic total mesorectal excision. Nevertheless, the costs and lack of haptic feedback remain the primary limitations to the widespread use of robotic technology in the field.
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Affiliation(s)
| | - Ho Seung Kim
- Department of Surgery, Division of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722 Korea
| | - Seung Yoon Yang
- Department of Surgery, Division of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722 Korea
| | - Nam Kyu Kim
- Department of Surgery, Division of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722 Korea
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Recurrence Risk after Radical Colorectal Cancer Surgery-Less Than before, But How High Is It? Cancers (Basel) 2020; 12:cancers12113308. [PMID: 33182510 PMCID: PMC7696064 DOI: 10.3390/cancers12113308] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Evidence indicates that recurrence risk after colon cancer today is less than it was when trials performed decades ago showed that adjuvant chemotherapy reduces the risk and prolong disease-free and overall survival. After rectal cancer surgery, local recurrence rates have decreased but it is unclear if systemic recurrences have. After a systematic review of available literature reporting recurrence risks after curative colorectal cancer surgery we report that the risks are lower today than they were in the past and that this risk reduction is not solely ascribed to the use of adjuvant therapy. Adjuvant therapy always means overtreatment of many patients, already cured by the surgery. Fewer recurrences mean that progress in the care of these patients has happened but also that the present guidelines giving recommendations based upon old data must be adjusted. The relative gains from adding chemotherapy are not altered, but the absolute number of patients gaining is less. Abstract Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment.
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Gómez Ruiz M, Lainez Escribano M, Cagigas Fernández C, Cristobal Poch L, Santarrufina Martínez S. Robotic surgery for colorectal cancer. Ann Gastroenterol Surg 2020; 4:646-651. [PMID: 33319154 PMCID: PMC7726686 DOI: 10.1002/ags3.12401] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022] Open
Abstract
Minimally invasive surgery has demonstrated many benefits in general surgery, particularly in colon and rectal procedures. On the other hand, it has some limitations that must be taken into account, especially technical drawback. Robotic surgery has incorporated many improvements to overcome this disadvantage, such as 3D visualization, articulating instruments assisting complex and precise movements. As a result, robotic colorectal surgery shows less intraoperative blood loss, shorter time to oral tolerance and initial flatus (particularly associated with "Enhanced Recovery After Surgery" protocol), less conversion rate to open surgery, shortened hospital stay, and longer distal margins compared to laparoscopic and open surgery. This approach also shows a shorter learning curve. Some studies suggest that it could decrease perioperatively or 30 days after the intervention's mortality, raise overall survival, reduce wound infection, and improve functional results, while others show no significant difference. However, it lengthens surgical time. Otherwise, the studies included do not show statistically significant changes in the number of resected lymph nodes and anastomotic leaks. Economic costs remain one of the major concerns, although to date there are no large-scale studies that have evaluated this aspect from a global point of view. Robotic surgery represents a qualitative leap in surgical instruments and, although there is no strong evidence in favor of the use of robotic surgery over laparoscopic or open surgery, there is enough evidence to support its use in colorectal surgery, with potential advantages for patients.
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Affiliation(s)
- Marcos Gómez Ruiz
- Colorectal Surgery UnitGeneral Surgery DepartmentMarqués de Valdecilla University HospitalSantanderSpain
- Valdecilla Biomedical Research Institute (IDIVAL)SantanderSpain
| | - Mario Lainez Escribano
- Colorectal Surgery UnitGeneral Surgery DepartmentMarqués de Valdecilla University HospitalSantanderSpain
| | - Carmen Cagigas Fernández
- Colorectal Surgery UnitGeneral Surgery DepartmentMarqués de Valdecilla University HospitalSantanderSpain
- Valdecilla Biomedical Research Institute (IDIVAL)SantanderSpain
| | - Lidia Cristobal Poch
- Colorectal Surgery UnitGeneral Surgery DepartmentMarqués de Valdecilla University HospitalSantanderSpain
- Valdecilla Biomedical Research Institute (IDIVAL)SantanderSpain
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Zhang X, Wu Q, Wei M, Ding Y, Gu C, Liu S, Wang Z. Low-residual diet versus clear-liquid diet for bowel preparation before colonoscopy: meta-analysis and trial sequential analysis of randomized controlled trials. Gastrointest Endosc 2020; 92:508-518.e3. [PMID: 32376331 DOI: 10.1016/j.gie.2020.04.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to compare a low-residual diet (LRD) with a clear-liquid diet (CLD) for bowel preparation before colonoscopy. METHODS A systematic literature search was performed in PubMed, Ovid, and Cochrane databases for randomized clinical trials comparing LRD with CLD for bowel preparation before colonoscopy. The last search was performed on September 20, 2019. The primary outcome was adequate bowel preparation. The outcomes were compared using systematic review with meta-analysis and trial sequential analysis (TSA). RESULTS Twenty randomized controlled trials published between 2005 and 2019 with 4323 participants were included. LRD was comparable with CLD for adequate bowel preparation (P = .79; odds ratio [OR], 0.96; 95% confidence interval [CI], 0.72-1.29). The detection rates for polyps (P = .68; OR, 1.04; 95% CI, 0.86-1.27) or adenomas (P = .78; OR, 1.03; 95% CI, 0.86-1.23) were similar between the groups. There were significantly fewer advents in individuals in the LRD group: nausea (P = .02; OR, 0.72; 95% CI, 0.56-0.94), vomiting (P = .04; OR, 0.61; 95% CI, 0.38-0.98), hunger (P < .001; OR, 0.36; 95% CI, 0.24-0.53), and headache (P = .02; OR ,0.64; 95% CI, 0.44-0.93). In addition, significantly more individuals in the LRD group found it easy to complete the diet (P = .01; OR, 1.86; 95% CI, 1.15-3.00) and showed willingness to repeat it (P = .005; OR, 2.23; 95% CI, 1.28-3.89). TSA demonstrated that the cumulative Z curve crossed both the traditional boundary and the trial sequential monitoring boundary for adequate bowel preparation. CONCLUSION The present study demonstrated that LRD was comparable with CLD in the quality of bowel preparation before colonoscopy. More clinical trials are needed to confirm other outcomes.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanling Ding
- Department of Cardiology, Anqing Municipal Hospital (Anqing Hospital Affiliated to Anhui Medical University), Anqing, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Sheng Liu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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