Clinical Science
Laparoscopic versus robotic rectal resection for rectal cancer in a veteran population

https://doi.org/10.1016/j.amjsurg.2013.01.036Get rights and content

Abstract

Background

Robotic rectal cancer resection remains controversial. We compared the safety and efficacy of laparoscopic vs robotic rectal cancer resection in a high-risk Veterans Health Administration population.

Methods

Patients who underwent minimally invasive rectal cancer resection were identified from an institutional colorectal cancer database. Baseline characteristics and outcomes were compared between robotic and laparoscopic groups.

Results

The robotic group (n = 13) did not differ significantly from the laparoscopic group (n = 59) with respect to baseline characteristics except for a higher rate of previous abdominal surgery. Robotic patients had significantly lower tumors, more advanced disease, a higher rate of preoperative chemoradiation, and were more likely to undergo abdominoperineal resection. Robotic rectal resection was associated with longer operative time. There were no differences in blood loss, conversion rates, postoperative morbidity, lymph nodes harvested, margin positivity, or specimen quality between groups.

Conclusions

The robotic approach for rectal cancer resection is safe with similar postoperative and oncologic outcomes compared with laparoscopy.

Section snippets

Database and sample population

The Michael E. DeBakey VA Medical Center (MEDVAMC) Colorectal Cancer Database—our institutional review board–approved database—was used exclusively for this study. This database, which is routinely updated by research personnel using the MEDVAMC electronic medical record, contains demographic, clinical, pathologic, and postoperative follow-up data for all patients with colorectal cancer who have been seen in the MEDVAMC surgical oncology clinic. All data used in the study were derived from the

Baseline characteristics of sample population

In all, 72 patients underwent minimally invasive rectal resection for rectal cancer; 59 had LRR and 13 had RRR. Characteristics of the entire study population are presented in Table 1. The mean age of the entire cohort was 65.4 ± 1.4 years, almost all patients (97%) were male, and the majority (71%) were white. The mean BMI was 28.4 ± 6.1 kg/m2, indicating an overweight population.

As expected from a VA population, most patients had extensive comorbidities, with 89% presenting with an ASA class

Comments

Open surgery continues to be the current standard of care for colorectal resections. However, minimally invasive laparoscopic colon resection is now an accepted alternative for colon cancer and has been associated with reduced postoperative morbidity, improved quality of life, and equivalent oncologic outcomes in several studies.2, 3, 4, 22 As a result, laparoscopic colon resection may become the standard of care for the surgical treatment of colon cancer in the near future.

The role of

Conclusions

Given our findings, within the context of the available literature, we can conclude that robotic rectal resections can be safely performed even in a high-risk population such as ours and that the surgical robot can increase the application of minimally invasive surgery to even the most difficult rectal cancer cases. With increasing familiarity and training of OR personnel, the few drawbacks of robotic rectal surgery, which are all related to efficiency, will be diminished. With forthcoming

References (32)

  • S. Trastulli et al.

    Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials

    Colorectal Dis

    (2012)
  • O. Aziz et al.

    Laparoscopic versus open surgery for rectal cancer: a meta-analysis

    Ann Surg Oncol

    (2006)
  • C. Laurent et al.

    Laparoscopic versus open surgery for rectal cancer: long-term oncologic results

    Ann Surg

    (2009)
  • J.A. Kemp et al.

    Nationwide trends in laparoscopic colectomy from 2000 to 2004

    Surg Endosc

    (2008)
  • C.N. Robinson et al.

    Minimally invasive surgery is underutilized for colon cancer

    Ann Surg Oncol

    (2011)
  • A.L. deSouza et al.

    Total mesorectal excision for rectal cancer: the potential advantage of robotic assistance

    Dis Colon Rectum

    (2010)
  • Cited by (0)

    The authors declare no conflicts of interest.

    This manuscript has been reviewed and approved by all authors. The study has not been previously published.

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