Innovation in technology is crucial for improving healthcare. Robotic technology in surgical practice [1] and nextgeneration sequencing (NGS) platforms in genomics research [2] represent the most promising technological advances for improving clinical outcomes of patients with complex diseases such as cancer. However, technological innovation in healthcare is an important driver of cost growth. Very often, physicians and patients seeking the best treatment embrace new modes of treatment before there is evidence-based clinical utility of new medical devices. It is obvious that comparative-effectiveness research (CER) is required before new medical devices, diagnostics or novel drugs are incorporated into clinical practice [3]. Robotic surgical devices allow a surgeon at a console to operate remote-controlled robotic arms, which may facilitate the performance of laparoscopic procedures. Laparoscopic surgery, in turn, is associated with shorter hospital stays than open surgery, as well as with less postoperative pain and scarring, lower risks of infection and need for blood transfusion, and better aesthetic result. All these advantages can be termed as better short-term quality of life (QOL). Evidence for the superiority of laparoscopic versus open surgery has already been documented for colon cancer, and there is also a trend for similar benefits in patients with rectal cancer and gastric cancer [4–9]. However, there is still no evidence that robotic-assisted surgery significantly improves outcomes and reduces adverse effects as compared with laparoscopic-assisted surgery, while by contrast it appears that it is associated with higher costs. The hypothesis that more appropriate and precise total mesorectal excision (TME) can lead to higher complete cancer resection (R0), lower rates of local and locoregional recurrence, and improved survival with robot-assisted surgery compared with laparoscopic resection [10] requires data from CER, which remain scarce. In the November issue of Surgical Endoscopy, Bianchi and colleagues [11] address the question of potential shortterm benefits of robotic versus laparoscopic surgery in the treatment of patients with middle or lower rectal adenocarcinoma. The authors analysed the data of 50 patients with proven middle/lower rectal adenocarcinoma who all underwent minimally invasive TME either with a four-arm Da Vinci S robot (Intuitive Surgical, Sunnyvale, CA, USA) (n = 25) or with laparoscopic technique (n = 25). The groups were well balanced. Most patients underwent anterior resections (74%) and the remaining underwent abdominoperineal resections (26%), while about half of patients received preoperative (neoadjuvant) chemotherapy. There was no significant difference in median operating time, first bowel movement, median hospital stay or complications between the two groups. Extent of lymphadenectomy as measured by the median number of lymph nodes examined was similar (18 vs. 17). Distal resection margins were disease free in both groups, but circumferential margin was involved in one patient (4%) of the laparoscopic group. There was only one conversion to laparotomy. The authors conclude that robotic TME for rectal cancer is feasible with similar short-term oncologic and QOL outcomes compared with laparoscopic TME. They note that whether the greater manoeuvrability and visibility afforded by the robotic approach can result in better outcomes than those of laparoscopic surgery can be answered by future, more systematic studies considering also the costs of robotic-assisted surgery. C. Hottenrott (&) Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Strase 3, 60487 Frankfurt, Germany e-mail: info@gastricbreastcancer.com
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Aug 21, 2014
Peter L Schilling + 1
Open Access
