Oncologic Outcomes of Robotic-Assisted Total Mesorectal Excision for the Treatment of Rectal Cancer
Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Namdong-gu, Incheon, Korea. Annals of surgery
(Impact Factor: 8.33).
05/2010; 251(5):882-6. DOI: 10.1097/SLA.0b013e3181c79114
To evaluate local recurrence and survival after robotic-assisted total mesorectal excision (RTME) for primary rectal cancer.
RTME is a novel approach for the treatment of rectal cancer and has been shown to be safe and effective. However, the oncologic results of this approach have not been reported in terms of local recurrence and survival rate.
Sixty-four consecutive rectal cancer patients with stage I-III disease treated between November 2004 and June 2008 were analyzed prospectively.
All patients underwent RTME: 34 had colorectal anastomosis, 18 underwent coloanal anastomosis, and 12 received abdominoperineal resection. Operative mortality rate was 0%. The median operative time was 270 min and median blood loss was 200 mL. The conversion rate was 9.4%. Anastomotic leakage occurred in 4 of 52 (7.7%) patients with anastomosis. Median number of harvested lymph nodes was 14.5. Median distal margin of tumor was 3.4 cm. The circumferential resection margin was negative in all surgical specimens. No port-site recurrence occurred in any patient. Six patients developed recurrence: 2 combined local and distant, and 4 distal alone (mean follow-up of 20.2 months; range, 1.7-52.5). None of the patients developed isolated local recurrence. The mean time to local recurrence was 23 months. The 3-year overall and disease-free survival rates were 96.2% and 73.7%, respectively.
RTME can be carried out safely and effectively in terms of recurrence and survival rates. Further prospective randomized trials are necessary to better define the absolute benefits and limitations of robotic rectal surgery.
Available from: PubMed Central
- "These results demonstrate the safety and feasibility of robot-assisted low anterior resection with better short-term outcomes. Moreover, the robotic system is likely to improve local disease control and eventually improve OS,. Another advantage of the robotic system is its less steep learning curve. "
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ABSTRACT: Laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades. Accumulating data have demonstrated that laparoscopic colectomy is associated with better short-term outcomes and equivalent oncologic outcomes when compared with open surgery. However, some controversies regarding the oncologic quality of mini-invasive surgery for rectal cancer exist. Meanwhile, some progresses in colorectal surgery, such as robotic technology, single-incision laparoscopic surgery, natural orifice specimen extraction, and natural orifice transluminal endoscopic surgery, have been made in recent years. In this article, we review the published data and mainly focus on the current status and latest advances of mini-invasive surgery for colorectal cancer.
Available from: Byung Soh Min
- "The quality or grade of (Total Mesorectal Excision) TME was evaluated only in 4 studies [26, 31, 34, 37]. Baik et al. report 4 cases of incomplete TME, 6 cases also with incomplete TME reported by Luka et al., and another 6 cases by Baek et al. "
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ABSTRACT: Aim. Robotic colorectal surgery may be a way to overcome the limitations of laparoscopic surgery. It is an emerging field; so, we aim in this paper to provide a comprehensive and data analysis of the available literature on the use of robotic technology in colorectal surgery. Method. A comprehensive systematic search of electronic databases was completed for the period from 2000 to 2011. Studies reporting outcomes of robotic colorectal surgery were identified and analyzed. Results. 41 studies (21 case series, 2 case controls, 13 comparative studies 1 prospective comparative, 1 randomized trial, 3 retrospective analyses) were reviewed. A total of 1681 patients are included in this paper; all of them use Da Vinci except 2 who use Zeus. Short-term outcome has been evaluated with 0 mortality and191 total major and minor complications. Pathological results were not analyzed in all studies and only 20 out of 41 provide data about the pathological results. Conclusion. Robotic surgery is safe and feasible option in colorectal surgery and a promising field; however, further prospective randomized studies are required to better define its role.
Available from: ncbi.nlm.nih.gov
- "Robotic surgical platforms have been proposed as a way to overcome the limitations described above for laparoscopic rectal cancer surgery. Although there are no randomized controlled trials for robotic TME for rectal cancer, several studies demonstrate similar operative duration, intraoperative and postoperative complication rates, and short-term outcomes when compared to laparoscopic controls [10, 11, 50–54]. Robotic TME has similar distal and circumferential radial margins when compared to laparoscopic controls, therefore demonstrating feasibility for this technique [10, 50–54]. "
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ABSTRACT: A rapid progression from conventional open surgery to minimally invasive approaches in the surgical management of colorectal cancer has occurred over the last 2 decades. Initial concerns that this new approach was oncologically inferior to open surgery were ultimately refuted when several prospective randomized trials concluded that laparoscopic colectomy could achieve similar oncologic outcomes to open surgery. On the contrary, level 1 data has not yet matured regarding the oncologic safety of minimally invasive approaches for rectal cancer. We review the published literature pertaining to the evolution of minimally invasive techniques used to treat colorectal cancer surgery, including barriers to adoption, and the prospects for future advances related to innovative techniques.
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