J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 55(7); 2012 > Article
Shin and Kim: Robotic versus laparoscopic surgery in colon and rectal cancer

Abstract

Laparoscopic surgery is an acceptable option for colorectal cancer. Robotic surgery is an emerging methodology and may be a solution to some difficulties inherent to conventional laparoscopic surgery. The aims of this study are to review the outcomes of laparoscopic and robotic surgery, and to discuss robotic surgery from the perspective of treating colorectal cancer. In rectal cancer, robotic surgery takes a longer operative time and has a higher cost, but decreases conversion to open surgery and shortens the learning curve. It has a great potential for preserving bladder and sexual function after total mesorectal excision (TME). The TME quality may also be better. Robotic surgery can also modify the current standard anastomosis following rectal resection, which is a double-stapling technique. Using a robot enables transanal specimen retrieval then a single-circular stapled anastomosis, which is associated with low pain and fast recovery. More solid answers including the long-term oncologic safety will be provided by ongoing randomized trials. In colon cancer, the ease of performing intracorporeal suture anastomosis may be a benefit. Since complete mesocolic excision with wide lymphadenectomy is becoming more and more acceptable to achieve better oncologic outcomes, the role of robotic surgery in providing a stable environment for radically dissecting lymph nodes should be evaluated. Recently developed new technologies such as fluorescent imaging and a robotic stapler seem promising potentially providing further benefits such as a decrease in anastomotic leakage. Single port robotic surgery is also an interesting concept requiring clinical evaluation. Robotic surgery is a developing field and may provide further functional and oncological benefits to colorectal cancer patients. Large scale randomized trials are timely important.

References

1. National Cancer Information Center. Cancer facts & figures 2009 in the Republic of Korea [Internet] 2011;cited 2012 Jun 26. Goyang: National Cancer Information Center. Available from: http://www.cancer.go.kr/ncic/cics_g/cics_g02/cics_g027/1647906_6065.html

2. D'Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 2004;47:2162-2168.

3. Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 2006;20:1521-1525.

4. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 2008;22:1601-1608.

5. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 2009;16:1480-1487.

6. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L. Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 2009;13:176-183.

7. Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 2010;24:2888-2894.

8. Park JS, Choi GS, Lim KH, Jang YS, Jun SH. Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 2010;17:3195-3202.

9. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS. Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 2011;54:151-156.

10. Baek JH, Pastor C, Pigazzi A. Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 2011;25:521-525.

11. Delaney CP, Lynch AC, Senagore AJ, Fazio VW. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 2003;46:1633-1639.

12. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL. Robotic versus laparoscopic colectomy. Surg Endosc 2007;21:1701-1708.

13. Spinoglio G, Summa M, Priora F, Quarati R, Testa S. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 2008;51:1627-1632.

14. DeSouza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H. Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 2010;53:1000-1006.

15. Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 2000;87:206-210.

16. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 2012;03. 21. [Epub]. DOI: 10.1245/s10434-012-2262-1.

17. Kang J, Min BS, Hur H, Kim NK, Lee KY. Transanal specimen extraction in robotic rectal cancer surgery. Br J Surg 2012;99:133-136.

18. Schiessel R, Novi G, Holzer B, Rosen HR, Renner K, Holbling N, Feil W, Urban M. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 2005;48:1858-1865.

19. Saito N, Ono M, Sugito M, Ito M, Morihiro M, Kosugi C, Sato K, Kotaka M, Nomura S, Arai M, Kobatake T. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum 2004;47:459-466.

20. Orsenigo E, Di Palo S, Vignali A, Staudacher C. Laparoscopic intersphincteric resection for low rectal cancer. Surg Oncol 2007;16:Suppl 1. S117-S120.

21. Fujimoto Y, Akiyoshi T, Kuroyanagi H, Konishi T, Ueno M, Oya M, Yamaguchi T. Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg 2010;14:645-650.

22. Leong QM, Son DN, Cho JS, Baek SJ, Kwak JM, Amar AH, Kim SH. Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc 2011;25:2987-2992.

23. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010;28:272-278.

24. Chaves JA, Idoate CP, Fons JB, Oliver MB, Rodriguez NP, Delgado AB, Lizoain JL. A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy. Cir Esp 2011;89:24-30.

25. Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR. Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 2002;60:39-45.

26. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G. Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003;138:777-784.

27. Hubens G, Coveliers H, Balliu L, Ruppert M, Vaneerdeweg W. A performance study comparing manual and robotically assisted laparoscopic surgery using the da Vinci system. Surg Endosc 2003;17:1595-1599.

28. Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003;170:1738-1741.

29. Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek JH. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 2010;17:1614-1620.

30. Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 2012;19:2095-2101.

31. Moloo H, Mamazza J, Poulin EC, Burpee SE, Bendavid Y, Klein L, Gregoire R, Schlachta CM. Laparoscopic resections for colorectal cancer: does conversion survival? Surg Endosc 2004;18:732-735.

32. Baek SJ, Kim SH, Cho JS, Shin JW, Kim J. Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 2011;[Submitted].

33. Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R, Garbett C, Guillou P, Holloway I, Howard H, Marshall H, McCabe C, Pavitt S, Quirke P, Rivers CS, Brown JM. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 2012;27:233-241.

34. Cahill RA, Ris F, Mortensen NJ. Near-infrared laparoscopy for real-time intra-operative arterial and lymphatic perfusion imaging. Colorectal Dis 2011;13:Suppl 7. 12-17.

Table 1
Demographics of the studies which we used in this analysis
jkma-55-620-i001-l.jpg

Lap, laparoscopic surgery; Ro, robotic surgery.

Table 2
Comparison of operative outcomes between robotic and laparoscopic resection for rectal cancer
jkma-55-620-i002-l.jpg

Lap, laparoscopic surgery; Ro, robotic surgery; LAR, low anterior resection; OT, operation time; NS, no statistical difference; EBL, estimated blood loss; LN, count of harvested lymph nodes; DRM, length of distal resection margin; HS, days of hospital stay; Con, conversion rate; SD, able to permit soft diet; ISR, intershpincteric resection; APR, abdominoperineal resection; CRM, positivity of circumferential resection margin.

*P<0.05.

Table 3
Comparison of operative outcomes between robotic and laparoscopic resection for colon cancer
jkma-55-620-i003-l.jpg

Lap, laparoscopic surgery; Ro, robotic surgery; EBL, estimated blood loss; NA, not available.

*P<0.05.

Table 4
Comparison of costs between robotic and laparoscopic resection for colorectal cancer
jkma-55-620-i004-l.jpg

Lap, laparoscopic surgery; Ro, robotic surgery; OR, operating room; NA, not available.

*P<0.05.



ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next