Nicola de'Angelis1,2, Margerita Notarnicola3, Aleix Martínez-Pérez4, Riccardo Memeo5, Cecile Charpy6, Irene Urciuoli3, Fabio Maroso3, Daniele Sommacale3, Aurelien Amiot7,8, Florence Canouï-Poitrine9,10, Eric Levesque11, Francesco Brunetti3. 1. Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. nic.deangelis@yahoo.it. 2. EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. nic.deangelis@yahoo.it. 3. Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 4. Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, 90, Av. de Gaspar Aguilar, 46017, Valencia, Spain. 5. Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Piazza Umberto I, 1, 70121, Bari, Italy. 6. Department of Pathology, Henri Mondor Hospital, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 7. EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. 8. Department of Gastroenterology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 9. Department of Public Health L, Henri Mondor University Hospital, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 10. University of Paris Est, Creteil (UPEC), IMRB-U955 INSERM, CEPiA, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 11. Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Abstract
BACKGROUND: The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (R-PME) versus laparoscopic (L-PME) PME for high RC. METHODS: This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum (>10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019. RESULTS: Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PME patients, except for operative time (220 min and 190 min, respectively; p < 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME. CONCLUSION: Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon's experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC.
BACKGROUND: The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (R-PME) versus laparoscopic (L-PME) PME for high RC. METHODS: This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum (>10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019. RESULTS: Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PMEpatients, except for operative time (220 min and 190 min, respectively; p < 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME. CONCLUSION: Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon's experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC.
Authors: Kamil Safiejko; Radoslaw Tarkowski; Maciej Koselak; Marcin Juchimiuk; Aleksander Tarasik; Michal Pruc; Jacek Smereka; Lukasz Szarpak Journal: Cancers (Basel) Date: 2021-12-30 Impact factor: 6.639