T L Ghezzi1, F Luca2, M Valvo3, O C Corleta4, M Zuccaro5, S Cenciarelli5, R Biffi5. 1. Division of Colorectal Surgery, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos Street 2350, 90035-903 Porto Alegre, Brazil. Electronic address: tlghezzi@terra.com.br. 2. Unit of Integrated Abdominal Surgery, Division of Abdominopelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: fabrizio.luca@ieo.it. 3. Unit of Integrated Abdominal Surgery, Division of Abdominopelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. 4. Department of Surgery and General Surgery Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. 5. Division of Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy.
Abstract
BACKGROUND: Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce. METHODS: The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared. RESULTS: There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P = 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P = 0.024). CONCLUSION: RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
BACKGROUND: Despite the several series in which the short-term outcomes of robotic-assisted surgery were investigated, data concerning the long-term outcomes are still scarce. METHODS: The prospectively collected records of 65 consecutive patients with extraperitoneal rectal cancer who underwent robotic total mesorectal excision (RTME) were compared with those of 109 consecutive patients treated with open surgery (OTME). Patient characteristics, pathological findings, local and systemic recurrence rates and 5-year survival rates were compared. RESULTS: There were no statistically significant differences in postoperative complications, reoperation and 30-day mortality. There were significant differences comparing groups: number of lymph nodes harvested (RTME: 20.1 vs. OTME: 14.1, P < 0.001), estimated blood loss (RTME: 0 vs. OTME: 150 ml, P = 0.003), operation time (RTME: 299.0 vs. OTME: 207.5 min, P < 0.001) and length of postoperative stay (RTME: 6 vs. OTME: 9 days, P < 0.001). The rate of circumferential resection margin involvement and distal resection margin were not statistically different between groups. There were no statistically significant differences at the 5-year follow-up: overall survival, disease-free survival and cancer-specific survival. The cumulative local recurrence rate was statistically lower in the robotic group (RTME: 3.4% vs. OTME: 16.1%, P = 0.024). CONCLUSION: RTME showed a significant reduction in local recurrence rate and a higher, although not statistically significant, long-term cancer-specific survival with respect to OTME. Prospective randomized studies are needed to confirm or deny significantly better local control rates with robotic surgery.
Authors: Hubert Perrin; Jean Claude Ortega; Guy Armando; Philippe Brunner; Patrick Hastier; Rémi Dumas; Charles Ferrari Journal: J Robot Surg Date: 2015-02-04
Authors: Francesco Feroci; Andrea Vannucchi; Paolo Pietro Bianchi; Stefano Cantafio; Alessia Garzi; Giampaolo Formisano; Marco Scatizzi Journal: World J Gastroenterol Date: 2016-04-07 Impact factor: 5.742
Authors: Benedetto Ielpo; H Duran; E Diaz; I Fabra; R Caruso; L Malavé; V Ferri; J Nuñez; A Ruiz-Ocaña; E Jorge; S Lazzaro; D Kalivaci; Y Quijano; E Vicente Journal: Int J Colorectal Dis Date: 2017-08-08 Impact factor: 2.571