Abstract
Simple SummarySurgery remains a mainstay of combined modality treatment at patients with rectal cancer; however, there is a growing interest in using laparoscopic techniques (LG); including robotic-assisted techniques (RG). Therefore, we have prepared a meta-analysis of the literature regarding the safety and efficacy of robotic versus laparoscopic approaches in patients undergoing curative surgery for rectal cancer. The results indicate a number of advantages of RG in terms of both safety and efficacy. Operative time in the RG group was shorter and associated with a statistically significantly lower conversion of the procedure to open surgery. RG technique provided a shorter duration of hospital stay and lowered urinary risk retention. No differences were found between these techniques regarding TNM stage; N stage or lymph nodes harvested. Survival to hospital discharge or 30-day overall survival rate was 99.6% in RG vs. 98.8% for LG.Robotic-assisted surgery is expected to have advantages over standard laparoscopic approach in patients undergoing curative surgery for rectal cancer. PubMed, Cochrane Library, Web of Science, Scopus and Google Scholar were searched from database inception to 10 November 2021, for both RCTs and observational studies comparing robotic-assisted versus standard laparoscopic surgery for rectal cancer resection. Where possible, data were pooled using random effects meta-analysis. Forty-Two were considered eligible for the meta-analysis. Survival to hospital discharge or 30-day overall survival rate was 99.6% for RG and 98.8% for LG (OR = 2.10; 95% CI: 1.00 to 4.43; p = 0.05). Time to first flatus in the RG group was 2.5 ± 1.4 days and was statistically significantly shorter than in LG group (2.9 ± 2.0 days; MD = −0.34; 95%CI: −0.65 to 0.03; p = 0.03). In the case of time to a liquid diet, solid diet and bowel movement, the analysis showed no statistically significant differences (p > 0.05). Length of hospital stay in the RG vs. LG group varied and amounted to 8.0 ± 5.3 vs. 9.5 ± 10.0 days (MD = −2.01; 95%CI: −2.90 to −1.11; p < 0.001). Overall, 30-days complications in the RG and LG groups were 27.2% and 19.0% (OR = 1.11; 95%CI: 0.80 to 1.55; p = 0.53), respectively. In summary, robotic-assisted techniques provide several advantages over laparoscopic techniques in reducing operative time, significantly lowering conversion of the procedure to open surgery, shortening the duration of hospital stay, lowering the risk of urinary retention, improving survival to hospital discharge or 30-day overall survival rate.
Highlights
Colorectal cancer remains the second most common cause of death in the Western world, and rectal localization accounts for approximately 25% of its cases
The risk of b1i0asstaucdcioersd(iFniggutroesthSe1–aSu4t)h.ors of the present study was low for 32 studies, moderate for 10 studies (Figures S1–S4)
Patient Chara3c.t2e.riPsatitciesnt Characteristics Detailed characteristics of the patients are presented in Tables 1 and S1
Summary
Colorectal cancer remains the second most common cause of death in the Western world, and rectal localization accounts for approximately 25% of its cases. Direct vision enabled by St Marks retractors and more extended tools allow one to resect mesorectum within the intact fascia, obtain a proper circumferential margin (CRM) and better oncologic radicalness through eradicating cancer deposits localized within mesorectum, resected en bloc together with and affected organ. This has been the opposite for former blunt resections performed directly with an unarmed surgeon hand, leaving part of the structures mentioned above with cancer cells within the pelvis as the gateway to local recurrence. The laparoscopic approach was superior to open surgery in terms of lower pain, faster recovery, shorter hospital stay and better cosmesis [3,4]
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