Robotic Rectal Cancer Surgery: Current Controversies
Current Surgery Reports - 2024
Tóm tắt
This review evaluates the current literature on robotic surgery for rectal cancer and discusses ongoing controversies related to outcomes, training, adoption, and cost-effectiveness. Robotic rectal surgery is associated with some benefits in short-term outcomes such as lower conversions compared to laparoscopy but also substantially higher costs. Data on long-term oncologic outcomes are still limited. Studies are inconsistent regarding benefits in margin positivity and other metrics. There is significant variability in training practices and adoption rates globally. Robotic rectal surgery is increasingly utilized, especially for low rectal cancers where laparoscopy is more challenging. It allows more patients to undergo minimally invasive total mesorectal excision. However, benefit over laparoscopy is unclear for less complex cases. Ongoing controversies exist related to true outcomes, optimal training, cost-effectiveness, and credentialing of surgeons. Further data from high-quality trials are needed to better determine the definitive role of robotic platforms.
Từ khóa
Tài liệu tham khảo
Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8. https://doi.org/10.1200/JCO.2006.09.7758.
Klaver CEL, Kappen TM, Borstlap WAA, Bemelman WA, Tanis PJ. Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis. Surg Endosc. 2017;31(12):4902–12. https://doi.org/10.1007/s00464-017-5544-7.
Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363(9416):1187–92. https://doi.org/10.1016/S0140-6736(04)15947-3.
Samalavicius NE, Janusonis V, Siaulys R, et al. Robotic surgery using Senhance® robotic platform: single center experience with first 100 cases. J Robot Surg. 2020;14(2):371–6. https://doi.org/10.1007/s11701-019-01000-6.
Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev. 2008;34(6):498–504. https://doi.org/10.1016/j.ctrv.2008.03.011.
da Silva GM, Börjesson L, Wexner SD. Laparoscopy for colorectal cancer. Semin Laparosc Surg. 2004;11(1):3–12. https://doi.org/10.1177/107155170401100102.
Fernández-Hevia M, Delgado S, Castells A, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. 2015;261(2):221–7. https://doi.org/10.1097/SLA.0000000000000865.
Wu WX, Sun YM, Hua YB, Shen LZ. Laparoscopic versus conventional open resection of rectal carcinoma: a clinical comparative study. World J Gastroenterol. 2004;10(8):1167–70. https://doi.org/10.3748/wjg.v10.i8.1167.
Tschann P, Weigl MP, Lechner D, et al. Is robotic assisted colorectal cancer surgery equivalent compared to laparoscopic procedures during the introduction of a robotic program? A propensity-score matched analysis. Cancers (Basel). 2022;14(13):3208. https://doi.org/10.3390/cancers14133208.
Gómez Ruiz M, Lainez Escribano M, Cagigas Fernández C, Cristobal Poch L, Santarrufina MS. Robotic surgery for colorectal cancer. Ann Gastroenterol Surg. 2020;4(6):646–51. https://doi.org/10.1002/ags3.12401.
Wang X, Cao G, Mao W, Lao W, He C. Robot-assisted versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis. J Cancer Res Ther. 2020;16(5):979–89. https://doi.org/10.4103/jcrt.JCRT_533_18.
••Emile SH, Horesh N, Freund MR, et al. Outcomes of laparoscopic versus robotic-assisted resection of T4 rectal cancer: propensity score-matched analysis of a national cancer database. Br J Surg. 2023;110(2):242–250. https://doi.org/10.1093/bjs/znac396. This 2023 study analyzed outcomes of robotic vs laparoscopic surgery specifically for advanced T4 rectal cancers using a large national database. It provides important evidence on robotic resection of high-risk rectal tumors
Crippa J, Grass F, Dozois EJ, et al. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort. Ann Surg. 2021;274(6):e1218–22. https://doi.org/10.1097/SLA.0000000000003805.
••Safiejko K, Tarkowski R, Koselak M, et al. Robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection: a systematic review and meta-analysis of 19,731 patients. Cancers (Basel). 2021;14(1):180. https://doi.org/10.3390/cancers14010180. This 2021 meta-analysis included nearly 20,000 patients comparing robotic to laparoscopic rectal cancer surgery. It provides a comprehensive analysis of perioperative and oncologic outcomes between the techniques.
Tong G, Zhang G, Zheng Z. Robotic and robotic-assisted vs Laparoscopic rectal cancer surgery: a meta-analysis of short-term and long-term results. Asian J Surg. 2021;44(12):1549. https://doi.org/10.1016/j.asjsur.2021.08.053.
Olthof PB, Giesen LJX, Vijfvinkel TS, Roos D, Dekker JWT. Transition from laparoscopic to robotic rectal resection: outcomes and learning curve of the initial 100 cases. Surg Endosc. 2021;35(6):2921–7. https://doi.org/10.1007/s00464-020-07731-0.
Wang Y, Liu Y, Han G, Yi B, Zhu S. The severity of postoperative complications after robotic versus laparoscopic surgery for rectal cancer: a systematic review, meta-analysis and meta-regression. PLoS ONE. 2020;15(10): e0239909. https://doi.org/10.1371/journal.pone.0239909.
Kim MJ, Park SC, Park JW, et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg. 2018;267(2):243–51. https://doi.org/10.1097/SLA.0000000000002321.
••Martins RS, Fatimi AS, Mahmud O, et al. Multidimensional quality of life after robotic versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis. World J Surg. 2023;47(5):1310–1319. https://doi.org/10.1007/s00268-023-06936-3. This 2023 systematic review specifically analyzed quality of life after robotic vs laparoscopic rectal resection, providing important data on patient-reported outcomes.
Flynn J, Larach JT, Kong JCH, et al. Operative and oncological outcomes after robotic rectal resection compared with laparoscopy: a systematic review and meta-analysis. ANZ J Surg. 2023;93(3):510–21. https://doi.org/10.1111/ans.18075.
Li L, Zhang W, Guo Y, et al. Robotic versus laparoscopic rectal surgery for rectal cancer: a meta-analysis of 7 randomized controlled trials. Surg Innov. 2019;26(4):497–504. https://doi.org/10.1177/1553350619839853.
Sun XY, Xu L, Lu JY, Zhang GN. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Minim Invasive Ther Allied Technol. 2019;28(3):135–42. https://doi.org/10.1080/13645706.2018.1498358.
Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2018;33(12):1741–53. https://doi.org/10.1007/s00384-018-3145-0.
Katsuno H, Hanai T, Masumori K, et al. Robotic surgery for rectal cancer: operative technique and review of the literature. J Anus Rectum Colon. 2020;4(1):14–24. https://doi.org/10.23922/jarc.2019-037.
Guo Y, Guo Y, Luo Y, Song X, Zhao H, Li L. Comparison of pathologic outcomes of robotic and open resections for rectal cancer: a systematic review and meta-analysis. PLoS ONE. 2021;16(1): e0245154. https://doi.org/10.1371/journal.pone.0245154.
Bao X, Wang H, Song W, Chen Y, Luo Y. Meta-analysis on current status, efficacy, and safety of laparoscopic and robotic ventral mesh rectopexy for rectal prolapse treatment: can robotic surgery become the gold standard? Int J Colorectal Dis. 2021;36(8):1685–94. https://doi.org/10.1007/s00384-021-03885-y.
••Cengiz TB, Benlice C, Ozgur I, et al. Cost-conscious robotic restorative proctectomy has similar economic and oncologic outcomes to open restorative proctectomy: Results of a long-term follow-up study. Int J Med Robot. 2021;17(6):e2331. https://doi.org/10.1002/rcs.2331. This 2021 study provided important long-term cost and oncologic outcome data on robotic vs open proctectomy to analyze value and cancer control.
••Yang H, Zhou L. The urinary and sexual outcomes of robot-assisted versus laparoscopic rectal cancer surgery: a systematic review and meta-analysis [published online ahead of print, 2023 Mar 21]. Surg Today. 2023; https://doi.org/10.1007/s00595-023-02671-3. This recent 2023 meta-analysis focused on urinary and sexual function outcomes comparing robotic to laparoscopic rectal surgery.