Russian multicenter experience of robot-assisted surgery in patients with rectal cancer

Objective: to compare short-term and long-term results of laparoscopic and robotic mesorectal excisions.
Material and methods. Our multi-center cohort study based on prospectively collected data included patients with rectal cancer (RC) who underwent laparoscopic and robotic surgeries between 2010 and 2016. Study participants were divided into 3 groups: laparoscopic surgery group (L), 1st robotic surgery group (R1, surgeries were performed during the 1st year after the implementation of the equipment) and 2nd robotic surgery group (R2, surgeries were performed later). We evaluated the quality of mesorectal excision conducted using laparoscopic and robotic surgical techniques on different stages of their implementation. Additionally, we estimated intra- and postoperative complications, duration of surgery, intraoperative blood loss, overall survival and relapse-free survival.
Results. Our groups consisted of 101 (L), 31 (R1) and 82 (R2) patients. Median surgery duration was 235 (110–465), 270 (130–420) and 193 (105–365) min in groups L, R1 and R2 respectively. The frequency of complications in these groups was 12 (11.9 %), 8 (25.8 %) and 9 (11.0 %) respectively. The frequency of R0-resections was 95.0 % (L), 90.3 % (R1) and 98.8 % (R2). The G2–3 mesorectal excision was performed in 87.9 % (L), 96.9 % (R1) and 96.1 % (R2) patients. Relapses were registered in 8 (8.6 %), 2 (6.5 %), and 2 (2.6 %) patients from groups L, R1 and R2 respectively. We observed no differences in relapse-free survival across the groups R1 and R2 (р = 0.131), L and R1 (р = 0.088), L and R2 (р = 0.794).
Conclusions. Robotic surgery can safely be used in patients with RC; however, it should be implemented into routine practice under the supervision of an expert within special training programs. The use of a robotic surgical system with an optimized docking system controlled by an experienced specialist allows reducing the duration of rectal surgery, does not increase the risk of postoperative complications and ensures a higher quality of mesorectal excision.

1. Stevenson A.R., Solomon M.J., Lumley J.W. et al. Effect of laparoscopic-assisted resection versus open resection on pathological outcomes in rectal cancer: the ALaCaRT Randomized Clinical Trial. JAMA 2015;314(13):1356–63. DOI: 10.1001/jama.2015.12009.

2. Fleshman J., Branda M., Sargent D. J. et al. Effect of laparoscopic-assisted resection versus open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 Randomized Clinical Trial. JAMA 2015;314(13):1346–55. DOI: 10.1001/jama.2015.10529.

3. Clavien P.A., Barkun J., de Oliveira M.L. et al. The Clavien–Dindo classification of surgical complications: 5-year experience. Ann Surg 2009;250(2):187–96. DOI: 10.1097/SLA.0b013e3181b13ca2.

4. Quirke P., Steele R., Monson J. et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCICCTG CO16 randomised clinical trial. Lancet 2009;373(9666):821–8. DOI: 10.1016/S0140-6736(09)60485-2.

5. Saklani A.P., Lim D.R., Hur H. et al. Robotic versus laparoscopic surgery for midlow rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Colorectal Dis 2013;28(12):1689–98. DOI: 10.1007/s00384-013-1756-z.

6. Feroci F., Vannucchi A., Bianchi P.P. et al. Total mesorectal excision for mid and low rectal cancer: laparoscopic versus robotic surgery. World J Gastroenterol 2016;22(13):3602–10. DOI: 10.3748/wjg.v22.i13.3602.

7. Kim Y.S., Kim M.J., Park S.C. et al. Robotic versus laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy: case-matched study of short-term outcomes. Cancer Res Treat 2016;48(1): 225–31. DOI: 10.4143/crt.2014.365.

8. Cho M.S., Baek S.J., Hur H. et al. Short and long-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a case-matched retrospective study. Medicine (Baltimore) 2015;94(11):e522. DOI: 10.1097/MD.0000000000000522.

9. Baik S.H., Kwon H.Y., Kim J.S. et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 2009;16(6):1480–7. DOI: 10.1245/s10434-009-0435-3.

10. Sun Y., Xu H., Li Z. et al. Robotic vs laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 2016: 14:61. DOI: 10.1186/s12957-016-0816-6.

11. Wilder F.G., Burnett A., Oliver J. et al. A review of the long-term oncologic outcomes of robotic surgery versus laparoscopic surgery for colorectal cancer. Indian J Surg 2016;78(3):214–9. DOI: 10.1007/s00464-013-3014-4.