Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis

K F Kowalewski,T Hackert,C Haney,S Seide,B P Müller-Stich,S Ali,L Seifert,C Tapking,A Shamiyeh,F Nickel,Y Kulu,M W Schmidt

doi:10.1007/s00464-019-07361-1

Abstract

Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision, survival has improved substantially. Consequently, more patients have to deal with side effects of treatment. The most recently introduced surgical technique is robotic-assisted surgery (RAS) which seems equally effective in terms of oncological control compared to laparoscopy. However, RAS enables further advantages which maximize the precision of surgery, thus providing better functional outcomes such as sexual function or contience without compromising oncological results. This review was done according to the PRISMA and AMSTAR-II guidelines and registered with PROSPERO (CRD42018104519). The search was planned with PICO criteria and conducted on Medline, Web of Science and CENTRAL. All screening steps were performed by two independent reviewers. Inclusion criteria were original, comparative studies for laparoscopy vs. RAS for rectal cancer and reporting of functional outcomes. Quality was assessed with the Newcastle–Ottawa scale. The search retrieved 9703 hits, of which 51 studies with 24,319 patients were included. There was a lower rate of urinary retention (non-RCTs: Odds ratio (OR) [95% Confidence Interval (CI)] 0.65 [0.46, 0.92]; RCTs: OR[CI] 1.29[0.08, 21.47]), ileus (non-RCTs: OR[CI] 0.86[0.75, 0.98]; RCTs: OR[CI] 0.80[0.33, 1.93]), less urinary symptoms (non-RCTs mean difference (MD) [CI] − 0.60 [− 1.17, − 0.03]; RCTs: − 1.37 [− 4.18, 1.44]), and higher quality of life for RAS (only non-RCTs: MD[CI]: 2.99 [2.02, 3.95]). No significant differences were found for sexual function (non-RCTs: standardized MD[CI]: 0.46[− 0.13, 1.04]; RCTs: SMD[CI]: 0.09[− 0.14, 0.31]). The current meta-analysis suggests potential benefits for RAS over laparoscopy in terms of functional outcomes after rectal cancer resection. The current evidence is limited due to non-randomized controlled trials and reporting of functional outcomes as secondary endpoints.

Highlights

Colorectal Cancer is currently the third most common cancer in the world and the rectum is affected in approximately one-third of cases [1]
As for rectal cancer in particular, a recent meta-analysis found no differences between conventional laparoscopy and robotic-assisted surgery (RAS) in terms of oncological outcomes [14]
A comprehensive database search including Medline, Web of Science and CENTRAL was performed as suggested by Goossen et al [24] until November 2018

Summary

Introduction

Colorectal Cancer is currently the third most common cancer in the world and the rectum is affected in approximately one-third of cases [1]. Surgery can be performed by either traditional open surgery or minimally invasive approaches International multicenter studies such as the COLOR II trial [5] or COREAN [6, 7] have proven the equivalence of laparoscopy and open surgery for oncological outcomes (e.g., 5-year disease-free survival), while ALaCaRT [8] and ACOSOG [9] showed equivocal results. As for rectal cancer in particular, a recent meta-analysis found no differences between conventional laparoscopy and RAS in terms of oncological outcomes [14]. Another meta-analysis compared open, RAS, laparoscopy, and transanal TME and found that laparoscopy and RAS enhance postoperative recovery, while open surgery and transanal TME may improve oncological resection [15]

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