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The short-term outcomes of robotic sphincter-preserving surgery for rectal cancer: comparison with open and laparoscopic surgery using a propensity score analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to clarify the short-term outcomes of robotic sphincter-preserving surgery for rectal cancer in a retrospective study.

Methods

The short-term outcomes of robotic sphincter-preserving surgery (n = 130) were retrospectively compared to open (n = 234) and laparoscopic surgery (n = 318) by a propensity score analysis.

Results

Robotic surgery was performed more frequently for patients with lower rectal cancer (55%) than open (30%, p < 0.0001) or laparoscopic surgery (36%, p < 0.0001). None of the robotic surgery cases were converted to open surgery. After propensity score matching, robotic surgery was found to be associated with a longer operation time (342 vs. 230 min, p < 0.0001) and less blood loss (7 vs. 420 mL, p < 0.0001) than open surgery. The overall complication rate of robotic surgery was lower than that of open surgery (13 vs. 28%, p = 0.032). Robotic surgery was associated with a lower incidence of surgical site infections (SSIs) than laparoscopic surgery (0 vs. 7%, p = 0.028). There were no cases of anastomotic leakage after robotic surgery. The circumferential resection margin was involved in 0.8% of the patients who underwent robotic surgery; the incidence did not differ among the treatment groups.

Conclusions

Although robotic surgery for rectal cancer was associated with a longer operation time, it was associated with a very low incidence of SSIs. The degree of safety was comparable to both open and laparoscopic surgery.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer J Int Cancer 127(12):2893–2917. https://doi.org/10.1002/ijc.25516

    Article  CAS  Google Scholar 

  2. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Ota D (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J med 350 (20):2050–2059. https://doi.org/10.1056/NEJMoa032651

  3. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52 5.1016/S1470–2045(08)70310–3 [doi]

    Article  PubMed  CAS  Google Scholar 

  4. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100(1):75–82. https://doi.org/10.1002/bjs.8945

    Article  PubMed  CAS  Google Scholar 

  5. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726. https://doi.org/10.1016/S0140-6736(05)66545-2

    Article  PubMed  Google Scholar 

  6. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal Cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal Cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009

    Article  PubMed  CAS  Google Scholar 

  8. Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R, Garbett C, Guillou P, Holloway I, Howard H, Marshall H, McCabe C, Pavitt S, Quirke P, Rivers CS, Brown JM (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Color Dis 27(2):233–241. https://doi.org/10.1007/s00384-011-1313-6

    Article  Google Scholar 

  9. Kim NK, Kang J (2010) Optimal Total Mesorectal excision for rectal Cancer: the role of robotic surgery from an Expert's view. J Kor Soc Coloproctol 26(6):377–387. https://doi.org/10.3393/jksc.2010.26.6.377

    Article  Google Scholar 

  10. Ishihara S, Watanabe T, Fukushima Y, Akahane T, Horiuchi A, Shimada R, Nakamura K, Hayama T, Yamada H, Nozawa K, Matsuda K, Hashiguchi Y (2014) Safety and factors contributing to the difficulty of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. Tech Coloproctol 18(3):247–255. https://doi.org/10.1007/s10151-013-1048-1

    Article  PubMed  CAS  Google Scholar 

  11. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493. https://doi.org/10.1245/s10434-012-2262-1

    Article  PubMed  Google Scholar 

  12. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP, Yun SH (2013) Urinary and erectile function in men after Total Mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal Cancer: a case-matched comparison. World J Surg 38:1834–1842. https://doi.org/10.1007/s00268-013-2419-5

    Article  Google Scholar 

  13. Ishihara S, Otani K, Yasuda K, Nishikawa T, Tanaka J, Tanaka T, Kiyomatsu T, Hata K, Kawai K, Nozawa H, Kazama S, Yamaguchi H, Sunami E, Kitayama J, Watanabe T (2015) Recent advances in robotic surgery for rectal cancer. Int J Clin Oncol 20(4):633–640. https://doi.org/10.1007/s10147-015-0854-z

    Article  PubMed  Google Scholar 

  14. Park SY, Choi GS, Park JS, Kim HJ, Choi WH, Ryuk JP (2013) Robotic-assisted transabdominal intersphincteric resection: a technique involving a completely abdominal approach and coloanal anastomosis. Surg Laparosc Endosc Percutan Tech 23(1):e5–e10. https://doi.org/10.1097/SLE.0b013e318275b27a

    Article  PubMed  Google Scholar 

  15. Kim JC, Lim SB, Yoon YS, Park IJ, Kim CW, Kim CN (2014) Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery. Surg Endosc 28(9):2734–2744. https://doi.org/10.1007/s00464-014-3509-7

    Article  PubMed  Google Scholar 

  16. Shihab OC, Taylor F, Bees N, Blake H, Jeyadevan N, Bleehen R, Blomqvist L, Creagh M, George C, Guthrie A, Massouh H, Peppercorn D, Moran BJ, Heald RJ, Quirke P, Tekkis P, Brown G (2011) Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg 98(12):1798–1804. https://doi.org/10.1002/bjs.7662

    Article  PubMed  CAS  Google Scholar 

  17. Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10(11):1053–1062. https://doi.org/10.1016/S1470-2045(09)70224-4

    Article  PubMed  Google Scholar 

  18. Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon rectum 49(11):1663–1672. https://doi.org/10.1007/s10350-006-0714-z

    Article  PubMed  Google Scholar 

  19. Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, Sugihara K (2009) Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon rectum 52(4):567–576. https://doi.org/10.1007/DCR.0b013e3181a1d994

    Article  PubMed  Google Scholar 

  20. Akiyoshi T, Matsueda K, Hiratsuka M, Unno T, Nagata J, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M (2015) Indications for lateral pelvic lymph node dissection based on magnetic resonance imaging before and after preoperative Chemoradiotherapy in patients with advanced low-rectal Cancer. Ann Surg Oncol 22:614–620. https://doi.org/10.1245/s10434-015-4565-5

    Article  Google Scholar 

  21. Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, Chang HJ, Lim SB, Choi HS, Park JG (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15(3):729–737. https://doi.org/10.1245/s10434-007-9696-x

    Article  PubMed  Google Scholar 

  22. Konishi T, Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Akiyoshi T, Yoshimatsu H, Watanabe T, Yamaguchi T, Muto T (2011) Multimedia article. Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surg Endosc 25(7):2358–2359. https://doi.org/10.1007/s00464-010-1531-y

    Article  PubMed  Google Scholar 

  23. Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, Sawada T (2001) Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon rectum 44(9):1274–1280

    Article  PubMed  CAS  Google Scholar 

  24. Kagawa H, Kinugasa Y, Shiomi A, Yamaguchi T, Tsukamoto S, Tomioka H, Yamakawa Y, Sato S (2014) Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surg Endosc 29:995–1000. https://doi.org/10.1007/s00464-014-3760-y

    Article  PubMed  Google Scholar 

  25. Bae SU, Saklani AP, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2014) Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series. Annals of surgical treatment and research 86(2):76–82. https://doi.org/10.4174/astr.2014.86.2.76

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon rectum 54(2):151–156. https://doi.org/10.1007/DCR.0b013e3181fec4fd

    Article  PubMed  Google Scholar 

  27. Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, Lee KY (2013) The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison--open, laparoscopic, and robotic surgery. Ann Surg 257(1):95–101. https://doi.org/10.1097/SLA.0b013e3182686bbd

    Article  PubMed  Google Scholar 

  28. Popescu I, Vasilescu C, Tomulescu V, Vasile S, Sgarbura O (2010) The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience. Acta chirurgica Iugoslavica 57(3):29–35

    Article  PubMed  CAS  Google Scholar 

  29. Kim HJ, Choi GS, Park JS, Park SY (2014) Multidimensional analysis of the learning curve for robotic total mesorectal excision for rectal cancer: lessons from a single surgeon's experience. Dis Colon rectum 57(9):1066–1074. https://doi.org/10.1097/dcr.0000000000000174

    Article  PubMed  Google Scholar 

  30. Tamhankar AS, Jatal S, Saklani A (2016) Total robotic radical rectal resection with da Vinci xi system: single docking, single phase technique. The international journal of medical robotics + computer assisted surgery: MRCAS. doi:https://doi.org/10.1002/rcs.1734

  31. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645. https://doi.org/10.1016/s1470-2045(10)70131-5

    Article  PubMed  Google Scholar 

  32. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218. https://doi.org/10.1016/s1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  33. Shibata J, Ishihara S, Tada N, Kawai K, Tsuno NH, Yamaguchi H, Sunami E, Kitayama J, Watanabe T (2015) Surgical stress response after colorectal resection: a comparison of robotic, laparoscopic, and open surgery. Tech Coloproctol 19:275–280. https://doi.org/10.1007/s10151-014-1263-4

    Article  PubMed  CAS  Google Scholar 

  34. Baek JH, Pastor C, Pigazzi A (2011) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25(2):521–525. https://doi.org/10.1007/s00464-010-1204-x

    Article  PubMed  Google Scholar 

  35. D'Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, Alfano G (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27(6):1887–1895. https://doi.org/10.1007/s00464-012-2731-4

    Article  PubMed  Google Scholar 

  36. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2011) S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25(1):240–248. https://doi.org/10.1007/s00464-010-1166-z

    Article  PubMed  Google Scholar 

  37. Ishihara S, Watanabe T, Nagawa H (2008) Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today 38(11):1063–1065. https://doi.org/10.1007/s00595-007-3740-0

    Article  PubMed  Google Scholar 

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Funding

This research is supported by the Project for Cancer Research And Therapeutic Evolution (P-CREATE) from the Japan Agency for Medical Research and Development (AMED).

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Soichiro Ishihara, Tomomichi Kiyomatsu, Kazushige Kawai, Toshiaki Tanaka, Keisuke Hata, Hiroaki Nozawa & Toshiaki Watanabe

  2. Department of Surgery, Saitama Cancer Center, 780, Oaza Komuro, Ina-cho, Kita Adachi-gun, Saitama, 362-0806, Japan

    Shinsuke Kazama

  3. Department of Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Eiji Sunami

Authors
  1. Soichiro Ishihara
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  2. Tomomichi Kiyomatsu
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  3. Kazushige Kawai
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  4. Toshiaki Tanaka
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  5. Keisuke Hata
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  7. Eiji Sunami
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  8. Hiroaki Nozawa
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  9. Toshiaki Watanabe
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Corresponding author

Correspondence to Toshiaki Watanabe.

Ethics declarations

The study protocol was approved by the local ethics committees of the University of Tokyo [reference number: 3252-(1)], and informed consent was obtained from all the patients. The research was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

Toshiaki Watanabe received lecture fees from Intuitive Surgical, Covidien, Olympus, and Johnson & Johnson. The remaining authors declare no conflicts of interest in association with the present study.

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Ishihara, S., Kiyomatsu, T., Kawai, K. et al. The short-term outcomes of robotic sphincter-preserving surgery for rectal cancer: comparison with open and laparoscopic surgery using a propensity score analysis. Int J Colorectal Dis 33, 1047–1055 (2018). https://doi.org/10.1007/s00384-018-3056-0

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