Robotic Surgery in Rectal Cancer^[*]

 

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Abstract

Rectal cancer is an important cause of morbidity and mortality worldwide. The most effective and curative treatment is surgery, and the standard procedure is total mesorectal excision, initially performed by open surgery and posteriorly by minimally invasive techniques. Robotic surgery is an emerging technology that is expected to overcome the limitations of the laparoscopic approach. It has several advantages, including a stable camera platform with high definition three-dimensional image, flexible instruments with seven degrees of freedom, a third arm for fixed retraction, fine motion scaling, excellent dexterity, ambidextrous capability, elimination of physiological tremors and better ergonomics, that facilitate a steady and precise tissue dissection. The main technical disadvantages are the loss of tactile sensation and tensile feedback and the complex installation process. The aim of the present study is to review the importance and benefits of robotic surgery in rectal cancer, particularly in comparison with the laparoscopic approach. Intraoperative estimated blood loss, short and long-term outcomes as well as pathological outcomes were similar between robotic and laparoscopic surgery. The operative time is usually longer in robotic surgery and the high costs are still its major drawback. Robotic surgery for rectal cancer demonstrated lower conversion rate to open surgery and benefits in urinary and sexual functions and has been established as a safe and feasible technique.

Resumo

O cancro do reto é uma importante causa de morbidade e mortalidade em todo o mundo. O único tratamento curativo e mais eficaz é a cirurgia, sendo que o procedimento padrão é a excisão total do mesoreto, inicialmente realizada por cirurgia aberta e mais tarde por técnicas minimamente invasivas. A cirurgia robótica é uma tecnologia emergente que pretende ultrapassar as limitações da laparoscopia. As vantagens incluem plataforma de câmera estável, imagem tridimensional com alta definição, instrumentos flexíveis com sete graus de liberdade, terceiro braço para retração fixa, movimentos finos, excelente destreza, ambidestria, eliminação do tremor fisiológico e maior conforto ergonômico, que facilitam uma disseção firme e precisa dos tecidos. As principais desvantagens técnicas são a perda da sensação táctil e feedback tensional e o complexo processo de instalação. O objetivo deste estudo é fazer uma revisão bibliográfica da importância e dos benefícios da cirurgia robótica no cancro do reto, particularmente em comparação com a cirurgia laparoscópica. A perda estimada de sangue intraoperatória, os outcomes a curto e longo-prazo e os outcomes patológicos foram equivalentes entre a cirurgia robótica e laparoscópica. O tempo operatório é geralmente mais longo na cirurgia robótica e os elevados custos são a sua principal desvantagem. A cirurgia robótica no cancro do reto demonstrou menor taxa de conversão para cirurgia aberta e benefícios nas funções urinária e sexual e está estabelecida como uma técnica segura e viável.

^* Study conducted at Universidade do Porto, Faculdade de Medicina, Departamento de Cirurgia Geral, Porto, Portugal

Publication History

Received: 08 June 2020

Accepted: 30 August 2020

Article published online:
24 May 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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• References

• 1 Global Cancer Observatory. Cancer Today [Internet]. Lyon, France: International Agency for Research on Cancer. [cited 2020 Jan 18]. Available from: https://gco.iarc.fr/today
  Google Scholar
• 2 Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?. Br J Surg 1982; 69 (10) 613-616
  CrossrefPubMedGoogle Scholar
• 3 Tomassi MJ, Taller J, Yuhan R, Ruan JH, Klaristenfeld DD. Robotic transanal minimally invasive surgery for the excision of rectal neoplasia: Clinical experience with 58 consecutive patients. Dis Colon Rectum 2019; 62 (03) 279-285
  CrossrefPubMedGoogle Scholar
• 4 Vignali A, Elmore U, Milone M, Rosati R. Transanal total mesorectal excision (TaTME): current status and future perspectives. Updates Surg 2019; 71 (01) 29-37
  CrossrefPubMedGoogle Scholar
• 5 Lee L, de Lacy B, Gomez Ruiz M. et al. A multicenter matched comparison of transanal and robotic total mesorectal excision for mid and low-rectal adenocarcinoma. Ann Surg 2019; 270 (06) 1110-1116
  CrossrefPubMedGoogle Scholar
• 6 Jones K, Qassem MG, Sains P, Baig MK, Sajid MS. Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial. World J Gastrointest Oncol 2018; 10 (11) 449-464
  CrossrefPubMedGoogle Scholar
• 7 Wells KO, Peters WR. Minimally invasive surgery for locally advanced rectal cancer. Surg Oncol Clin N Am 2019; 28 (02) 297-308
  CrossrefPubMedGoogle Scholar
• 8 Nozawa H, Watanabe T. Robotic surgery for rectal cancer. Asian J Endosc Surg 2017; 10 (04) 364-371
  CrossrefPubMedGoogle Scholar
• 9 Li X, Wang T, Yao L. et al. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore) 2017; 96 (29) e7585
  CrossrefPubMedGoogle Scholar
• 10 Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc 2017; 31 (07) 2798-2807
  CrossrefPubMedGoogle Scholar
• 11 Schmiegelow AFT, Broholm M, Gögenur I, Fode M. Evaluation of sexual and urinary function after implementation of robot-assisted surgery for rectal cancer: A single-center study. Surg Laparosc Endosc Percutan Tech 2016; 26 (02) 141-145
  CrossrefPubMedGoogle Scholar
• 12 Wang G, Wang Z, Jiang Z, Liu J, Zhao J, Li J. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 2017;13(01):
  Google Scholar
• 13 Ishihara S, Otani K, Yasuda K. et al. Recent advances in robotic surgery for rectal cancer. Int J Clin Oncol 2015; 20 (04) 633-640
  CrossrefPubMedGoogle Scholar
• 14 Alsowaina KN, Schlachta CM, Alkhamesi NA. Cost-effectiveness of current approaches in rectal surgery. Ann Med Surg (Lond) 2019; 45: 36-39
  CrossrefPubMedGoogle Scholar
• 15 Hoshino N, Sakamoto T, Hida K, Sakai Y. Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence. Surg Today 2019; 49 (07) 556-570
  CrossrefPubMedGoogle Scholar
• 16 Kim CN, Bae SU, Lee SG. et al. Clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer: initial results in a center for minimally invasive surgery. Int J Colorectal Dis 2016; 31 (04) 843-852
  CrossrefPubMedGoogle Scholar
• 17 Grass JK, Perez DR, Izbicki JR, Reeh M. Systematic review analysis of robotic and transanal approaches in TME surgery- A systematic review of the current literature in regard to challenges in rectal cancer surgery. Eur J Surg Oncol 2019; 45 (04) 498-509
  CrossrefPubMedGoogle Scholar
• 18 Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL. Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: An update systematic review and meta-analysis of randomized controlled trials. Asian J Surg 2019; 42 (06) 657-666
  CrossrefPubMedGoogle Scholar
• 19 Ohtani H, Maeda K, Nomura S. et al. Meta-analysis of robot-assisted versus laparoscopic surgery for rectal cancer. In Vivo 2018; 32 (03) 611-623
  PubMedGoogle Scholar
• 20 Ahmed J, Cao H, Panteleimonitis S, Khan J, Parvaiz A. Robotic vs laparoscopic rectal surgery in high-risk patients. Colorectal Dis 2017; 19 (12) 1092-1099
  CrossrefPubMedGoogle Scholar
• 21 Valverde A, Goasguen N, Oberlin O. et al. Robotic versus laparoscopic rectal resection for sphincter-saving surgery: pathological and short-term outcomes in a single-center analysis of 130 consecutive patients. Surg Endosc 2017; 31 (10) 4085-4091
  CrossrefPubMedGoogle Scholar
• 22 Chen ST, Wu MC, Hsu TC. et al; Health Economics and Outcome Research Group, National Taiwan University Hospital. Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: A propensity score matched analysis of nationwide inpatient sample data. J Surg Oncol 2018; 117 (03) 497-505
  CrossrefPubMedGoogle Scholar
• 23 Sun XY, Xu L, Lu JY, Zhang GN. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Minim Invasive Ther Allied Technol 2019; 28 (03) 135-142
  CrossrefPubMedGoogle Scholar
• 24 Sugoor P, Verma K, Chaturvedi A. et al. Robotic versus laparoscopic sphincter-preserving total mesorectal excision: A propensity case-matched analysis. Int J Med Robot 2019; 15 (01) e1965
  CrossrefPubMedGoogle Scholar
• 25 Prete FP, Pezzolla A, Prete F. et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Ann Surg 2018; 267 (06) 1034-1046
  CrossrefPubMedGoogle Scholar
• 26 Alfieri S, Di Miceli D, Menghi R. et al. Single-docking full robotic surgery for rectal cancer: A single-center experience. Surg Innov 2018; 25 (03) 258-266
  CrossrefPubMedGoogle Scholar
• 27 Mégevand JL, Lillo E, Amboldi M, Lenisa L, Ambrosi A, Rusconi A. TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique-cumulative experience in a single centre. Updates Surg 2019; 71 (02) 331-338
  CrossrefPubMedGoogle Scholar
• 28 Li L, Zhang W, Guo Y. et al. Robotic versus laparoscopic rectal surgery for rectal cancer: A meta-analysis of 7 randomized controlled trials. Surg Innov 2019; 26 (04) 497-504
  CrossrefPubMedGoogle Scholar
• 29 Quero G, Rosa F, Ricci R. et al. Open versus minimally invasive surgery for rectal cancer: a single-center cohort study on 237 consecutive patients. Updates Surg 2019; 71 (03) 493-504
  CrossrefPubMedGoogle Scholar
• 30 Tang B, Zhang C, Li C. et al. Robotic total mesorectal excision for rectal cancer: A series of 392 cases and mid-term outcomes from a single center in china. J Gastrointest Surg 2017; 21 (03) 569-576
  CrossrefPubMedGoogle Scholar
• 31 Tsukamoto S, Nishizawa Y, Ochiai H. et al. Surgical outcomes of robot-assisted rectal cancer surgery using the da Vinci Surgical System: a multi-center pilot Phase II study. Jpn J Clin Oncol 2017; 47 (12) 1135-1140
  CrossrefPubMedGoogle Scholar
• 32 Matsuyama T, Kinugasa Y, Nakajima Y, Kojima K. Robotic-assisted surgery for rectal cancer: Current state and future perspective. Ann Gastroenterol Surg 2018; 2 (06) 406-412
  CrossrefPubMedGoogle Scholar
• 33 Lee SG, Russ AJ, Casillas Jr MA. Laparoscopic transanal minimally invasive surgery (L-TAMIS) versus robotic TAMIS (R-TAMIS): short-term outcomes and costs of a comparative study. Surg Endosc 2019; 33 (06) 1981-1987
  CrossrefPubMedGoogle Scholar
• 34 Huang YJ, Huang YM, Wang WL, Tong YS, Hsu W, Wei PL. Surgical outcomes of robotic transanal minimally invasive surgery for selected rectal neoplasms: A single-hospital experience. Asian J Surg 2020; 43 (01) 290-296
  CrossrefPubMedGoogle Scholar
• 35 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 2018; 33 (08) 1047-1055
  CrossrefPubMedGoogle Scholar
• 36 Crolla RMPH, Mulder PG, van der Schelling GP. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc 2018; 32 (11) 4562-4570
  CrossrefPubMedGoogle Scholar
• 37 Feroci F, Vannucchi A, Bianchi PP. et al. Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery. World J Gastroenterol 2016; 22 (13) 3602-3610
  CrossrefPubMedGoogle Scholar
• 38 Jayne D, Pigazzi A, Marshall H. et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: The ROLARR randomized clinical trial. JAMA 2017; 318 (16) 1569-1580
  CrossrefPubMedGoogle Scholar
• 39 Ielpo B, Duran H, Diaz E. et al. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs. Int J Colorectal Dis 2017; 32 (10) 1423-1429
  CrossrefPubMedGoogle Scholar
• 40 Liao G, Li YB, Zhao Z, Li X, Deng H, Li G. Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Sci Rep 2016; 6: 26981
  CrossrefPubMedGoogle Scholar
• 41 Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 2015; 19 (03) 516-526
  CrossrefPubMedGoogle Scholar
• 42 Wang Y, Zhao GH, Yang H, Lin J. A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech 2016; 26 (03) 259-264
  CrossrefPubMedGoogle Scholar
• 43 Sun Y, Xu H, Li Z. et al. Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 2016; 14: 61
  CrossrefPubMedGoogle Scholar
• 44 Melstrom K. Robotic rectal cancer surgery. Cancer Treat Res 2016; 168: 295-308
  CrossrefPubMedGoogle Scholar
• 45 Kwak JM, Kim SH. Robotic surgery for rectal cancer: An update in 2015. Cancer Res Treat 2016; 48 (02) 427-435
  CrossrefPubMedGoogle Scholar
• 46 Rouanet P, Bertrand MM, Jarlier M. et al. Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: Results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol 2018; 25 (12) 3572-3579
  CrossrefPubMedGoogle Scholar
• 47 Bedirli A, Salman B, Yuksel O. Robotic versus laparoscopic resection for mid and low rectal cancers. JSLS 2016; 20 (01) e2015.00110
  CrossrefPubMedGoogle Scholar
• 48 Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2018; 33 (12) 1741-1753
  CrossrefPubMedGoogle Scholar
• 49 Lee SH, Lim S, Kim JH, Lee KY. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Ann Surg Treat Res 2015; 89 (04) 190-201
  CrossrefPubMedGoogle Scholar
• 50 Hopkins MB, Geiger TM, Bethurum AJ. et al. Comparing pathologic outcomes for robotic versus laparoscopic Surgery in rectal cancer resection: a propensity adjusted analysis of 7616 patients. Surg Endosc 2020; 34 (06) 2613-2622
  CrossrefPubMedGoogle Scholar
• 51 Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR. Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 2014; 28 (02) 456-465
  CrossrefPubMedGoogle Scholar
• 52 van der Schatte Olivier RH, Van't Hullenaar CDP, Ruurda JP, Broeders IAMJ. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 2009; 23 (06) 1365-1371
  CrossrefPubMedGoogle Scholar
• 53 Zihni AM, Ohu I, Cavallo JA, Cho S, Awad MM. Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc 2014; 28 (12) 3379-3384
  CrossrefPubMedGoogle Scholar
• 54 Tarr ME, Brancato SJ, Cunkelman JA, Polcari A, Nutter B, Kenton K. Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. J Minim Invasive Gynecol 2015; 22 (02) 234-238
  CrossrefPubMedGoogle Scholar
• 55 Hubert N, Gilles M, Desbrosses K, Meyer JP, Felblinger J, Hubert J. Ergonomic assessment of the surgeon's physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot 2013; 9 (02) 142-147
  CrossrefPubMedGoogle Scholar
• 56 Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 2006; 20 (10) 1521-1525
  CrossrefPubMedGoogle Scholar
• 57 Asklid D, Gerjy R, Hjern F, Pekkari K, Gustafsson UO. Robotic vs laparoscopic rectal tumour surgery: a cohort study. Colorectal Dis 2019; 21 (02) 191-199
  CrossrefPubMedGoogle Scholar
• 58 Eskicioglu C, Forbes SS, Aarts MA, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 2009; 13 (12) 2321-2329
  CrossrefPubMedGoogle Scholar
• 59 Bo T, Chuan L, Hongchang L, Chao Z, Huaxing L, Peiwu Y. Robotic versus laparoscopic rectal resection surgery: Short-term outcomes and complications: A retrospective comparative study. Surg Oncol 2019; 29: 71-77
  CrossrefPubMedGoogle Scholar
• 60 Corbellini C, Biffi R, Luca F. et al. Open, laparoscopic, and robotic surgery for rectal cancer: medium-term comparative outcomes from a multicenter study. Tumori 2016; 102 (04) 414-421
  CrossrefPubMedGoogle Scholar
• 61 Chang W, Wei Y, Ren L. et al. Short-term and long-term outcomes of robotic rectal surgery - from the real word data of 1145 consecutive cases in China. Surg Endosc 2019
  PubMedGoogle Scholar
• 62 Liao G, Zhao Z, Deng H, Li X. Comparison of pathological outcomes between robotic rectal cancer surgery and laparoscopic rectal cancer surgery: A meta-analysis based on seven randomized controlled trials. Int J Med Robot 2019; 15 (05) e2027
  CrossrefPubMedGoogle Scholar
• 63 Esen E, Aytac E, Ağcaoğlu O. et al. Totally robotic versus totally laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech 2018; 28 (04) 245-249
  CrossrefPubMedGoogle Scholar
• 64 de Jesus JP, Valadão M, de Castro Araujo RO, Cesar D, Linhares E, Iglesias AC. The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer. Eur J Surg Oncol 2016; 42 (06) 808-812
  CrossrefPubMedGoogle Scholar
• 65 Milone M, Manigrasso M, Velotti N. et al. Completeness of total mesorectum excision of laparoscopic versus robotic surgery: a review with a meta-analysis. Int J Colorectal Dis 2019; 34 (06) 983-991
  CrossrefPubMedGoogle Scholar
• 66 Kim HJ, Choi GS, Park JS, Park SY, Yang CS, Lee HJ. The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis 2018; 20 (05) O103-O113
  CrossrefPubMedGoogle Scholar
• 67 Tang X, Wang Z, Wu X, Yang M, Wang D. Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis. World J Surg Oncol 2018; 16 (01) 196
  CrossrefPubMedGoogle Scholar
• 68 Broholm M, Pommergaard HC, Gögenür I. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis 2015; 17 (05) 375-381
  CrossrefPubMedGoogle Scholar
• 69 Ramallo-Solis I, Jimenez-Rodriguez RM, Reyes-Diaz ML. et al. Influence of robotics in surgical complication rate in elderly population with rectal cancer. Aging Clin Exp Res 2019
  PubMedGoogle Scholar