Impact of robotic approach in complex rectal cancer: A comparative study of rectal mobilization time by robot versus laparoscopy.

Gyu-Seog Choi, Hye Jin Kim, Jun Seok Park, Soo Yeun Park, Hee Jae Lee. Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea

Aim: On the assumption that mechanical advantages of a surgical robot may help the surgeons to facilitate rectal mobilization remarkably easier in complex rectal cancers, we tried to identify clinical impact of surgical robot on time for rectal mobilization (Trm) in comparison to laparoscopy.

Methods & Results: From November, 2010 till July, 2015, Trm was checked in 155 and 95 rectal cancer patients (excluding APR and ISR) by laparoscopy and robot, respectively. A multivariate analysis identified four independent risk factors for longer Trm in laparoscopy which were lower tumor location (<5 cm from anal verge), preoperative chemoradiation, higher BMI (>25 kg/m2) and male sex. Subsequently, according to number of risk factors, we categorized these patients into three groups, 84 cases of easy (0-1 risk factor), 45 of moderate (2) and 26 of difficult (3-4) group. Also, we divided robotic group into three subgroups (24, 35 and 36 cases) with same parameters to compare results with laparoscopy group. Total operation time was significantly longer in robotic group (203.8±76.7 min) than laparoscopy group (145.8±57.4 min). In easy and moderate group, Trm was significantly longer in robotic group (easy group: 29.6 vs. 40.7min, P = 0.001; moderate group: 34.3 vs 46.7min, P < 0.001). Interestingly, Trm in difficult case was no longer different between the groups (laparoscopic group vs. robotic group, 52.2 vs. 55.3min, P = 0.549). Additionally all three subgroups demonstrated significantly low volume of blood loss in robotic group (easy group: 21.5 vs 14.6ml, P = 0.004; moderate group: 27.6 vs. 17.9ml, P = 0.005, difficult groups; 44.0 vs. 18.5ml, P < 0.001)

Conclusions: Despite nature of a surgical robot resulted in longer operation time, rectal mobilization in complex cases was easily completed with significantly clearer surgical field. Our data enlightened potentials of robotic approach in selected patients with rectal cancer.

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