Wai Lun Law, Dominic C Foo. The University of Hong Kong
Introduction : Laparoscopic resection for rectal cancer has been proven to be feasible and oncologically safe. However, it is a complex procedure and there are limitations with the current equipment and instruments. The surgical robotic system can overcome some of these limitations and facilitate the procedure. This study aimed to compare the short-term as well as oncologic outcomes of robotic rectal resection with laparoscopic resection.
Methods: Patients who suffered from mid to distal rectal cancer (within 12 cm from the anal verge) and underwent laparoscopic or robotic low anterior resection from January 2008 to June 2015 were included. Data were collected prospectively and comparison was made between the laparoscopic and the robotic groups.
Results: During the study period, 171 and 220 consecutive patients underwent laparoscopic and robotic rectal resection for cancer, respectively. The mean age was 65.9 years in both groups (p=0.98). The median tumor distance was 8 cm and 7 cm from the anal verge for laparoscopic and robotic groups, respectively (p=0.06). More patients in the robotic group had comorbidity (p=0.03) and preoperative chemoradiation (0.019). Abdominoperineal resection was performed in 9.9% and 5% in the laparoscopic and robotic groups, respectively. The median operating time for robotic resection was significantly longer, 260 min vs. 225min (p<0.001). Conversion rates of laparoscopic and robotic were 3.5% and 0.8%, respectively (p=0.308). The median hospital stay was 6 days. (p=0.29). There was no difference in the stage of disease, distal margin or positive circumferential margin rates. Complications rates of laparoscopic and robotic surgery were 22.2% and 19.1%, respectively (p=0.528). There was a significantly higher incidence of postoperative urinary retentions in L-TME 10.5% vs. 4.1% (p=0.024). The 5-year cancer specific survivals were similar in the two groups (79.1% vs. 81.9%, p=0.829)(Figure) and there was no difference in the local recurrence rate.
Conclusions: In the treatment of mid to low rectal cancer, robotic-assisted approach is associated with a low conversion and a high sphincter preservation rate. It also offered better bladder function after the operation. The oncologic outcomes were similar to laparoscopic resection.