Jan-Hendrik Egberts1,2, Jan-Niclas Kersebaum3, Benno Mann4, Heiko Aselmann5, Markus Hirschburger6, Julia Graß7, Thomas Becker3, Jakob Izbicki7, Daniel Perez7. 1. Clinic for Visceral Surgery, Israelitisches Krankenhaus Hamburg, Hamburg, Germany. J.Egberts@ik-h.de. 2. Clinic for General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kie, Kiel, Germany. J.Egberts@ik-h.de. 3. Clinic for General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kie, Kiel, Germany. 4. Clinic for Visceral Surgery, Augusta-Kranken-Anstalten Bochum, Bochum, Germany. 5. Clinic for General, Visceral, and Vascular Surgery, KRH Klinikum Robert Koch Gehrden, Gehrden, Germany. 6. Clinic for General, Visceral, and Thoracic Surgery, Clinic Worms, Worms, Germany. 7. Clinic for General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
PURPOSE: To define the best possible outcomes for robotic-assisted low anterior rectum resection (RLAR) using total mesorectal excision (TME) in low-morbid patients, performed by expert robotic surgeons in German robotic centers. The benchmark values were derived from these results. METHODS: The data was retrospectively collected from five German expert centers. After patient exclusion (prior surgery, extended surgery, no prior anastomosis, hand-sewn anastomosis), the benchmark cohort was defined (n = 226). The median with interquartile range was first calculated for the individual centers. The 75th percentile of the median results was defined as the benchmark cutoff and represents the "perfect" achievable outcome. This applied to all benchmark values apart from lymph node yield, where the cutoff was defined as the 25th percentile (more lymph nodes are better). RESULTS: The benchmark values for conversion and intraoperative complication rates were ≤ 4.0% and ≤ 1.4%, respectively. For postoperative complications, the benchmark was ≤ 28% for "any" and ≤ 18.0% for major complications. The R0 and complete TME rate benchmarks were both 100%, with a lymph node yield of > 18. The benchmark for rate of anastomotic insufficiency was < 12.5% and 90-day mortality was 0%. Readmission rates should not exceed 4%. CONCLUSION: This outcome analysis of patients with low comorbidity undergoing RLAR may serve as a reference to evaluate surgical performance in robotic rectum resection.
PURPOSE: To define the best possible outcomes for robotic-assisted low anterior rectum resection (RLAR) using total mesorectal excision (TME) in low-morbid patients, performed by expert robotic surgeons in German robotic centers. The benchmark values were derived from these results. METHODS: The data was retrospectively collected from five German expert centers. After patient exclusion (prior surgery, extended surgery, no prior anastomosis, hand-sewn anastomosis), the benchmark cohort was defined (n = 226). The median with interquartile range was first calculated for the individual centers. The 75th percentile of the median results was defined as the benchmark cutoff and represents the "perfect" achievable outcome. This applied to all benchmark values apart from lymph node yield, where the cutoff was defined as the 25th percentile (more lymph nodes are better). RESULTS: The benchmark values for conversion and intraoperative complication rates were ≤ 4.0% and ≤ 1.4%, respectively. For postoperative complications, the benchmark was ≤ 28% for "any" and ≤ 18.0% for major complications. The R0 and complete TME rate benchmarks were both 100%, with a lymph node yield of > 18. The benchmark for rate of anastomotic insufficiency was < 12.5% and 90-day mortality was 0%. Readmission rates should not exceed 4%. CONCLUSION: This outcome analysis of patients with low comorbidity undergoing RLAR may serve as a reference to evaluate surgical performance in robotic rectum resection.
Authors: Fabian Rössler; Gonzalo Sapisochin; GiWon Song; Yu-Hung Lin; Mary Ann Simpson; Kiyoshi Hasegawa; Andrea Laurenzi; Santiago Sánchez Cabús; Milton Inostroza Nunez; Andrea Gatti; Magali Chahdi Beltrame; Ksenija Slankamenac; Paul D Greig; Sung-Gyu Lee; Chao-Long Chen; David R Grant; Elizabeth A Pomfret; Norihiro Kokudo; Daniel Cherqui; Kim M Olthoff; Abraham Shaked; Juan Carlos García-Valdecasas; Jan Lerut; Roberto I Troisi; Martin De Santibanes; Henrik Petrowsky; Milo A Puhan; Pierre-Alain Clavien Journal: Ann Surg Date: 2016-09 Impact factor: 12.969
Authors: Heiko Aselmann; Jan-Niclas Kersebaum; Alexander Bernsmeier; Jan Henrik Beckmann; Thorben Möller; Jan Hendrik Egberts; Clemens Schafmayer; Christoph Röcken; Thomas Becker Journal: Int J Colorectal Dis Date: 2018-07-04 Impact factor: 2.571
Authors: A Agha; A Fürst; I Iesalnieks; S Fichtner-Feigl; N Ghali; D Krenz; M Anthuber; K W Jauch; P Piso; H J Schlitt Journal: Int J Colorectal Dis Date: 2008-04 Impact factor: 2.571