Fewer Complications Seen With Robotic Surgery In Rectal Cancer

In patients with rectal cancer, robotic surgery is associated with superior results compared with a traditional laparoscopic approach, according to a new analysis.

As, "Clearly robotics has many advantages for patients and surgeons in rectal cancer. We have proven in previous publications that robotic surgery is easier—both cognitively and physically," Dr. David W. Larson of Mayo Clinic, in Rochester, MN, told Reuters Health by email. "The improved ergonomics, vision, dexterity and ease of use lead to improved operations."

In the current study, published in Annals of Surgery, Dr. Larson and colleagues reviewed records on 600 patients who had surgery for rectal cancer with a mini-invasive approach at that institution between 2005 and 2018. The team notes that in 2010 a multimodal colorectal enhanced-recovery program became the standard perioperative-care protocol.

A little more than half of the patients underwent robotic surgery and the remaining ones had traditional laparoscopic surgery. The latter group had a significantly shorter operative time (214 vs. 324 minutes). However, patients undergoing robotic surgery had a significantly lower overall complications rate (37.2% vs 51.2%). They also had lower transfusion requirements (1.9% vs 7.8%).

The robotic group also had a significantly shorter median length of hospital stay (3 vs 5 days) and a lower proportion had a prolonged hospital stay (21% vs 43%). Having a complication and conversion to open surgery were risk factors for prolonged hospital stay, whereas robotic surgery was the only protective factor (odds ratio, 0.62).

"All surgeons know that complications and improved outcomes in value begin in the OR. Therefore, it is not surprising that complications, bleeding and length of stay are lower with robotics," Dr. Larson concluded.

Dr. Elin R. Sigurdson, a professor of surgical oncology at Fox Chase Cancer Center in Philadelphia, told Reuters Health by email, "It is easy to assume that robotic surgery provides shorter stays in the hospital, less postoperative pain, fewer wound complications, compared to open surgery, and is worth the substantial cost. However, in comparing robotic surgery to laparoscopic surgery, it is difficult to see that there would be much difference in 30-day complications."

"In this study, length of stay, and other acute complications, are difficult to separate from the impact of the enhanced-recovery regimen that occurred in the middle of this study," noted Dr. Sigurdson, who was not involved in the research.

"However," he added, "in other malignancies, robotic surgery has been associated with worse oncologic outcomes. This study provides reassuring results that while expensive, robotic surgery provided equal or improved acute outcomes, without evidence of compromise of the oncologic outcomes, as assessed by margin status. Careful follow-up for local-regional recurrences will be necessary to provide definitive evidence that oncologic outcomes are not compromised."

The study had no specific funding, and the authors report no conflicts of interest.

—David Douglas

Source