Robotic Versus Open Rectal Resection for Cancer: A Comparative Analysis of Oncological Safety and Short-term Outcomes in 164 Patients

Paolo Pietro Bianchi, MD, Wanda Petz, MD, Bruno Andreoni*, Pr, Antonio Chiappa*, MD, Emilio Bertani*, MD, Lorenzo Casali, MD, Daniele Belotti, MD, Matias Parodi, MD. Unit of Minimally-Invasive Surgery, * Division of General Surgery, European Institute of Oncology

 

Introduction. Minimally invasive surgery of the rectum for cancer has not still become a standard of care. We assessed feasibility, short-term oncologic safety and short-term outcomes in robotic rectal resection (RR) for cancer compared with open rectal resection (OR) in two homogenous groups of patients treated in the same surgical division.

Patients and methods. From February 2008 to September 2011 164 patients were retrospectively studied from a prospective data base, 80 patients underwent OR and 84 patients underwent RR. In patients with locally-advanced non metastatic tumor pre operative chemo-radiotherapy was administered. Sphincter preservation was realized every time the lesion was localized at least 3 cm above the anal verge. The robot utilized was a 4 arms DaVinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA).

Results Patients in the two groups were comparable in terms of mean age (65 years in OR and 65 in RR), mean body mass index (26 kg/m2 in OR and 25 kg/m2 in RR) and cancer stage. Seventeen abdomino-perineal resection were performed in OR group and 16 in RR group; mean surgical time was 200 minutes in OR and 274 minutes in RR (p:0.001), mean blood loss was 216 ml in OR and 88 ml in RR (p:0.02). One conversion to open surgery was necessary in the RR. Mean hospitalisation time was 11 days in OR group and 7 days RR group (p:0.001). Postoperative complications were 31% in OR and 15% in RR (p: 0.007) and the surgical site infections were 13% and 1% respectively (p:0.001). Mean number of harvested lymph nodes per patient was 18 OR and 22 in RR, mean distal resection margin was 2.9 cm and 4.3 cm respectively.

Conclusions. Robotic rectal resection for cancer is a feasible and safe operation with short-term oncologic outcomes similar to those of OR but with a significant less incidence of postoperative complications and hospital stay. Further studies are necessary to address more systematically advantages of robotic surgery in rectal cancer.


Session Number: Poster – Poster Presentations
Program Number: P080
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