Volume 16, Issue 8 pp. 603-609

Original article

Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic cases

M. Barnajian,

M. Barnajian

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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D. Pettet III,

D. Pettet III

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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E. Kazi,

E. Kazi

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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C. Foppa,

C. Foppa

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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R. Bergamaschi,

Corresponding Author

R. Bergamaschi

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

Correspondence to: Roberto Bergamaschi, MD, PhD, FRCS, FASCRS, FACS, Division of Colon & Rectal Surgery, Health Science Center T18, Suite 046B, State University of New York, Stony Brook, NY 11794-8191, USA.

E-mail: [email protected]

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M. Barnajian,

M. Barnajian

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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D. Pettet III,

D. Pettet III

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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E. Kazi,

E. Kazi

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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C. Foppa,

C. Foppa

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

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R. Bergamaschi,

Corresponding Author

R. Bergamaschi

Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

E-mail: [email protected]

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First published: 19 April 2014

https://doi.org/10.1111/codi.12634

Citations: 50

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Abstract

Aim

There are concerns about the impact of robotic proctectomy on the quality of total mesorectal excision (TME) and the impact of laparoscopic proctectomy on the depth of the circumferential resection margin (CRM). The aim of this study was to compare the first 20 consecutive robotic proctectomies performed in our unit with matched series of open and laparoscopic proctocolectomy performed by the same surgeon.

Method

Data on the first 20 consecutive patients treated with robotic proctectomy for rectal cancer, <12 cm from the anal verge, by the senior author (RB) were extracted from a prospectively maintained database. Groups of patients treated with open and laparoscopic proctectomy, matched for age, gender and body mass index (BMI) with those undergoing robotic proctectomy, were selected. The quality of the TME was judged as complete, nearly complete or incomplete. CRM clearance was reported in millimetres. Physiological parameters and operative severity were assessed.

Results

Age (P = 0.619), Physiological and Operative Severity Score for the Enumeration of Morbidity and Mortality (POSSUM) score (P = 0.657), operative severity score (P = 0.977), predicted mortality (P = 0.758), comorbidities (P = 0.427), previous abdominal surgery (P = 0.941), tumour height (P = 0.912), location (P = 0.876), stage (P = 0.984), neoadjuvant chemoradiation (P = 0.625), operating time (P = 0.066), blood loss (P = 0.356), ileostomy (P = 0.934), conversion (P = 0.362), resection type (P = 1.000), flatus (P = 0.437), diet (P = 0.439), length of hospital stay (P = 0.978), complications (P = 0.671), reoperations (P = 0.804), reinterventions (P = 0.612), readmissions (P = 0.349), tumour size (P = 0.542; P = 0.532; P = 0.238), distal margin (P = 0.790), nodes harvested (P = 0.338) and pathology stage (P = 0.623) did not differ among the three groups. The quality of TME showed a trend to be lower following robotic surgery, although this was not statistically significant [open 95/5/15 (complete/nearly complete/incompete) vs laparoscopic 95/5/15 vs robotic 80/5/15; P = 0.235], but the degree of clearance at the CRM was significantly greater in robotic patients [open 8 (0–30) mm vs laparoscopic 4 (0–30) mm vs robotic 10.5 (1–30) mm; P = 0.02].

Conclusion

The study reports no statistically significant difference between open and laparoscopic techniques in the quality of TME during the learning curve of robotic proctectomy for rectal cancer and demonstrates an improved CRM.

References

1Lindsey I. Who should treat rectal cancer and how? Colorectal Dis 2012; 14: 1439–40.
10.1111/codi.12070
CAS PubMed Web of Science® Google Scholar
2Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 28: 1479–82.
10.1016/S0140-6736(86)91510-2
Google Scholar
3Quirke P, Dixon MF. The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorect Dis 1988; 3: 127–31.
10.1007/BF01645318
CAS PubMed Web of Science® Google Scholar
4Nagtegaal ID, van de Velde CJ, van der Worp E et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 2002; 20: 1729–34.
10.1200/JCO.2002.07.010
PubMed Web of Science® Google Scholar
5Bhlat OS, Haluck RS, Murray WB, Gorman PJ, Krummel TM. Tactile feedback is present during minimally invasive surgery. J Am Coll Surg 1999; 189: 349–55.
10.1016/S1072-7515(99)00184-2
PubMed Web of Science® Google Scholar
6Monson JRT, Fleming FJ, Iannuzzi JC. Colorectal surgery training and patient safety: dissonance in an era of quality reporting. Colorectal Dis 2013; 15: 785–7.
10.1111/codi.12235
CAS PubMed Web of Science® Google Scholar
7Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986; 2: 996–9.
10.1016/S0140-6736(86)92612-7
CAS PubMed Web of Science® Google Scholar
8Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 2006; 20: 1521–5.
10.1007/s00464-005-0855-5
CAS PubMed Web of Science® Google Scholar
9Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA 1961; 178: 261–6.
10.1001/jama.1961.03040420001001
CAS PubMed Web of Science® Google Scholar
10Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg 1998; 85: 1217–20.
10.1046/j.1365-2168.1998.00840.x
CAS PubMed Web of Science® Google Scholar
11Edge SB, Byrd RD, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual, 7th edition. New York: Springer, 2010.
10.1007/978-0-387-88441-7
CAS PubMed Google Scholar
12Kim YW, Lee HM, Kim NK, Min BS, Lee KY. The learning curve for robot-assisted total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech 2012; 22: 400–5.
10.1097/SLE.0b013e3182622c2d
PubMed Web of Science® Google Scholar
13Jiménez-Rodríguez RM, Díaz-Pavón JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 2013; 28: 815–21.
10.1007/s00384-012-1620-6
PubMed Web of Science® Google Scholar
14Baik SH, Kim NK, Lee KY et al. Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol 2008; 15: 721–8.
10.1245/s10434-007-9706-z
PubMed Web of Science® Google Scholar
15Chern H, Chou J, Donkor C et al. Effects of obesity in rectal cancer surgery. J Am Coll Surg 2010; 2010: 55–60.
10.1016/j.jamcollsurg.2010.03.010
Web of Science® Google Scholar
16Leonard D, Penninckx F, Fieuws S et al. PROCARE, a multidisciplinary Belgian Project on Cancer of the Rectum. Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg 2010; 252: 982–8.
10.1097/SLA.0b013e3181efc142
PubMed Web of Science® Google Scholar
17Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E. Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis 2013; 15: 463–9.
10.1111/codi.12026
CAS PubMed Web of Science® Google Scholar
18van der Pas MH, Haglind E, Cuesta MA et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013; 2013: 210–8.
Google Scholar
19Lin S, Jiang H-G, Yu J-R. Meta-analysis of robotic and laparoscopic surgery for the treatment of rectal cancer. World J Gastroenterol 2011; 17: 5214–20.
10.3748/wjg.v17.i47.5214
PubMed Web of Science® Google Scholar
20Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 2012; 2012: 2095–101.
10.1245/s10434-012-2270-1
Web of Science® Google Scholar
21Park 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: 3195–202.
10.1245/s10434-010-1162-5
PubMed Web of Science® Google Scholar
22Kwak 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: 151–6.
10.1007/DCR.0b013e3181fec4fd
PubMed Web of Science® Google Scholar
23Kim NK, Kang J. Optimal total mesorectal excision for rectal cancer: the role of robotic surgery from an expert's view. J Korean Soc Coloproctol 2010; 26: 377–87.
10.3393/jksc.2010.26.6.377
PubMed Google Scholar
24Kang J, Yoon KJ, Min BS et al. The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison–open, laparoscopic, and robotic surgery. Ann Surg 2013; 257: 95–101.
10.1097/SLA.0b013e3182686bbd
Web of Science® Google Scholar
25D'Annibale A, Pernazza G, Monsellato I et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 2013; 27: 1887–95.
10.1007/s00464-012-2731-4
PubMed Web of Science® Google Scholar
26Nagtegaal ID, Marijnen CA, Kranenbarg EK et al. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002; 26: 350–7.
10.1097/00000478-200203000-00009
PubMed Web of Science® Google Scholar
27Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ. Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 2010; 12: 1084–93.
10.1111/j.1463-1318.2009.01999.x
CAS PubMed Web of Science® Google Scholar
28Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A. Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 2007; 14: 3168–73.
10.1245/s10434-007-9544-z
PubMed Web of Science® Google Scholar
29Hellan M, Stein H, Pigazzi A. Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. Surg Endosc 2009; 23: 447–51.
10.1007/s00464-008-0193-5
PubMed Web of Science® Google Scholar
30Zawadzki M, Velchuru VR, Albalawi SA, Park JJ, Marecik S, Prasad LM. Is hybrid robotic laparoscopic assistance the ideal approach for restorative rectal cancer dissection? Colorectal Dis 2013; 15: 1026–32.
10.1111/codi.12209
CAS PubMed Web of Science® Google Scholar
31Fernandez R, Anaya DA, Li LT et al. Laparoscopic versus robotic rectal resection for rectal cancer in a veteran population. Am J Surg 2013; 206: 509–17.
10.1016/j.amjsurg.2013.01.036
PubMed Web of Science® Google Scholar
32Akmal Y, Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Robot-assisted total mesorectal excision: is there a learning curve? Surg Endosc 2012; 26: 2471–6.
10.1007/s00464-012-2216-5
PubMed Web of Science® Google Scholar
33Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 2013; 27: 3297–307.
10.1007/s00464-013-2909-4
PubMed Web of Science® Google Scholar

Citing Literature

Volume16, Issue8

August 2014

Pages 603-609

Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic cases

Abstract

Aim

Method

Results

Conclusion

References

Citing Literature

References

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Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic cases

Abstract

Aim

Method

Results

Conclusion

References

Citing Literature

References

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