Soo Yeun Park, Jun Seok Park, Hye Jin Kim, Sung-Min Lee, Gyu-Seog Choi. Colorectal Cancer Center, Kyungpook National University Chilgok Hospital
Background: Robotic surgery has been suggested as an option for total mesorectal excision, with the expectation of the improvement in the clinical outcomes. The long-term oncologic impact of robotic rectal cancer surgery has not been clearly delineated.
Purpose: The aim of this study is to investigate the long-term oncologic outcomes of robotic total mesorectal excision for mid/low rectal cancer, in comparison with the outcomes of laparoscopic surgery.
Method: This is a retrospective study at a single tertiary university hospital. An institutional database was researched for all consecutive patients who underwent laparoscopic or robotic surgery for stage I–III mid/low rectal cancer between January 2009 and December 2013. Patients who underwent intersphincteric resection or lateral pelvic lymph node dissection were excluded. There were a total of 533 patients, of whom 415 patients underwent laparoscopic surgery and 118 patients underwent robotic surgery. Propensity score analyses were performed to compare oncologic outcomes for each group in a 1:1 case-matched cohort. The main outcomes were 5-year disease-free, 5-year pelvic-recurrence, and 5-year distant recurrence rate.
Results: 118 patients were included in each group, and the two groups were well balanced in terms of basic characteristics, perioperative treatment, and pathologic stage. Conversion to open surgery was observed in one case in the laparoscopic group. The circumferential resection margin was positive (less than 1 mm) in one case in the robotic group. The 5-year disease- free survival rate was 87.5%% in the laparoscopic group, and 86.6% in the robotic group (p = 0.772). The 5-year pelvic recurrence rate was 6.2% and 5.6%, respectively (p = 0.720). The 5-year distant recurrence rate was 10.4% and 10.0%, respectively (p = 0.942). The location of the pelvic recurrence was not significantly different between the two groups. Multivariate analysis revealed that preoperative chemoradiation, pT3-4 tumors, and pN2 were independently related to disease-free survival. In patients who had preoperative chemoradiation and pT3-4 tumors, the 5-year disease-free survival rate and 5-year distant recurrence rate were 58.3% and 41.7% in the laparoscopic group and 81.3% and 9.8% in the robotic group (p = 0.136 and p = 0.029, respectively).
Conclusion: Robotic surgery for mid/low rectal cancer showed similar long-term oncologic outcomes with laparoscopic surgery. It is warrant to prove whether patients with risk factors of disease recurrence can be considered as an appropriate candidate for robotic surgery in the future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95008
Program Number: S131
Presentation Session: Colorectal III
Presentation Type: Podium