The impact of robotic total mesorectal excision on survival of patients with rectal cancer—a propensity matched analysis

• Published in: International journal of colorectal disease Vol. 34; no. 12; pp. 2081 - 2089
• Main Authors: Tejedor, P., Sagias, F., Flashman, K., Lee, Yeh Han, Naqvi, S., Kandala, N., Khan, Jim
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2019; Springer
• Subjects: Aged; Aged, 80 and over; Anastomotic Leak - etiology; Cancer patients; Colorectal cancer; Comparative analysis; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - mortality; Disease-Free Survival; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Laparoscopy - adverse effects; Laparoscopy - mortality; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoplasm Staging; Original Article; Patient outcomes; Proctology; Propensity Score; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; Risk Assessment; Risk Factors; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - mortality; Surgery; Time Factors; Robotic surgery; Laparoscopic surgery; Total mesorectal excision; Oncologic outcome; Rectal cancer; Survival
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-019-03417-9

Introduction Robotic surgery can overcome some limitations of laparoscopic total mesorectal excision (L-TME), improving the quality of the surgery. We aim to compare the medium-term oncological outcomes of L-TME vs. robotic total mesorectal excision (R-TME) for rectal cancer. Methods A retrospective analysis was performed including patients who underwent L-TME or R-TME between 2011 and 2017. Patients presenting with metastatic disease or R1 resection were excluded. From a total of 680 patients, 136 cases of R-TME were matched based on age, gender, stage and time of follow-up with an equal number of patients who underwent L-TME. We compared 3-year disease-free survival (DFS) and overall survival (OS). Results Major complications were lower in the robotic group (13.2% vs. 22.8%, p = 0.04), highlighting the anastomotic leakage rate (7.4% vs. 16.9%, p = 0.01). The 3-year DFS rate for all stages was 69% for L-TME and 84% for R-TME ( p = 0.02). For disease stage III, the 3-year DFS was significantly higher in the R-TME group. OS was also significantly superior in the robotic group for every stage, reaching 86% in stage III. In the multivariate analysis, R-TME was a significant positive prognostic factor for distant metastasis (OR 0.2 95% CI 0.1, 0.6, p = 0.001) and OS (OR 0.2 95% CI 0.07, 0.4, p = 0.000). Moreover, major complications were also found to have a negative impact on OS (OR 8.3 95% CI 3.2, 21.6, p = 0.000). Conclusion R-TME for rectal cancer can achieve better oncological outcomes compared with L-TME, especially in stage III rectal cancers. However, a longer follow-up period is needed to confirm these findings.