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Robotic approach improves the quality of total mesorectal excision for complex rectal cancer: A comparative study of robot versus laparoscopy

Hye-Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Sung Min Lee. Kyungpook National University Chilgok Hospital

Background: Robotic surgery has many mechanical advantages over laparoscopic surgery. However, few studies have proven its clinical benefits in rectal cancer surgery. We aimed to identify clinical impact of surgical robot on time for rectal mobilization (Trm) and quality of total mesorectal excision (TME) in comparison to laparoscopy.

Methods: Between 2011 and 2017, Trm was checked in 245 and 147 rectal cancer patients undergoing TME by laparoscopy or robot, respectively. In the laparoscopic group, multivariate analysis identified four risk factors for longer Trm: male sex, lower tumor location (<6cm from anal verge), preoperative chemoradiation, and higher BMI (>25 kg/m2). According to the number of risk factors, we categorized all patients into three groups: easy (0-1 risk factor), moderate (2), and difficult (3-4).

Results: Total operation time and Trm were significantly longer in the robotic group than the laparoscopy group. However, Trm in the difficult group was not different between the groups (laparoscopic vs. robotic group, 59.2 vs. 56.5 min, P = 0.483). Additionally, all three subgroups demonstrated significantly low volume of blood loss in the robotic group. Lastly, quality of TME was similar between the groups for all patients, but in the difficult group, it was significantly better in the robotic group (complete, laparoscopic vs. robotic group, 66.7 vs. 87.8%, P = 0.041).

Conclusion: Robotic approach can easily complete rectal mobilization in difficult cases with significantly clearer surgical field. Subsequently, the quality of TME was improved by the robotic approach in these patients.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95169

Program Number: S066

Presentation Session: Residents and Fellows Session

Presentation Type: ResFel

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