Robotic versus standard laparoscopic total mesorectal excision for rectal cancer: a comparative study of short-term and oncological outcomes

Abstract

Robotic versus standard laparoscopic total mesorectal excision for rectal cancer: a comparative study of short-term and oncological outcomes Jarrod KH Tan,1 Frederick HX Koh,2 Charles BS Tsang,1,3,4 Dean Chi-Siong Koh1,3,41Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2Department of Surgery, National University Health System, Singapore; 3Division of Surgical Oncology, National University Cancer Institute, Singapore; 4Colorectal Clinic Associates, Mount Elizabeth Novena Hospital, SingaporeIntroduction: Laparoscopic total mesorectal excision (TME) is the standard operation for minimal access surgical treatment for rectal cancers. The superiority of the different laparoscopic modalities used to perform TME remains controversial. This study aims to compare the short-term outcomes between robotic TME (R-TME) and the standard laparoscopic TME (ST-TME).Methods: A retrospective review of all patients (n=42) diagnosed with mid/lower rectal carcinoma who underwent R-TME and ST-TME from October 2004 to November 2011 was performed. Patient demographics, perioperative outcomes, and histopathological findings were analyzed.Results: There were 23 patients treated with R-TME. Patient demographics were comparable between both groups. The median operating time was 242 (191–377) minutes in ST-TME and 395 (289–771) minutes in R-TME (P<0.001). ST-TME was associated with a higher conversion rate, at 21.0%, compared to the 4.3% in R-TME (P=0.158). Both groups had a median duration of intravenous analgesia of 2 days (P=0.602), and a median length of hospital stay of 6 (ST-TME) and 7 days (R-TME) (P=0.202). Morbidity rates were 31.6% and 21.7% in the ST-TME and R-TME groups, respectively (P=0.504). The median number of lymph nodes harvested was the same in each group, at 14 (P=0.323). Completeness of TME and margin positivity were similar for both groups.Conclusion: R-TME is safe and feasible, with similar postoperative and surrogate oncological outcomes when compared to ST-TME. While associated with a lower conversion rate, the longer operating time reflects the steep learning curve required to master the technique.Keywords: robotic, standard laparoscopic, total mesorectal excision, rectal cancer, Da Vinci, rectal cancer, laparoscopy, proctectomy