DOI: 10.1002/ags3.12007
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Robotic surgery for colorectal cancer Robotic surgery (RS) for colorectal disease was first reported in 1
compare RS versus standard LS for the curative treatment of rectal can-
2002. Since then, many studies of RS have been widely reported.
cer. The results presented at the European Society of Coloproctology in
Technical advantages of the da Vinci robotic system could overcome
2015 showed that there was no difference in terms of oncological clear-
the limitation of laparoscopic surgery (LS) for colorectal cancer, by
ance, perioperative morbidity, mortality and conversion to open surgery
giving the surgeon a 3D view, no tremor, better ergonomics,
between the two groups. However the trial is yet to be published, and
enhanced dexterity, precision and a short learning curve.
the results of long-term outcomes are yet to be analyzed. This trial will
Recently, several meta-analyses of randomized controlled trials to compare the safety and efficacy of RS and LS have been
provide further information about the efficacy of RS compared with LS and may give us the final decision for RS of rectal cancer.
reported. Trastulli et al. identified eight non-randomized studies that
RS for colorectal cancer is still under development and will
included a total of 858 patients who underwent surgery for rectal
improve instrumentation and haptic feedback with advances in tech-
cancer with 344 (40.2%) in the RS group and 510 (59.7%) in the LS
nology. The most important point is whether or not RS is superior to
group. Meta-analysis suggested that the conversion rate to open sur-
LS in oncological outcome and patients’ quality of life. The high cost
gery with RS was significantly lower than that with LS (odds ratio
of RS is another problem. If these problems are clarified, the status
[OR] = 0.26, 95% confidence interval [CI]: 0.12–0.57, P = 0.0007).
of RS in rectal cancer will be promising.
There were no significant differences in operation time, length of Chu Matsuda1
hospital stay, time to resume regular diet, postoperative morbidity
Yosuke Adachi2
2
and mortality, and oncological accuracy of resection.
Lin et al. also conducted a meta-analysis and reported that RS
1
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
had favorable outcomes considering conversion compared with LS for rectal cancer. Meanwhile, the following factors were similar
2
Center for the Study of Medical Education, School of Medicine,
between RS and LS: operation time, blood loss, days to passing fla-
Kurume University, Kurume, Japan
tus, length of hospital stay, complications and pathological details,
Email:
[email protected]
including number of lymph nodes harvested, distal resection margin, and positive circumferential resection margin.3 Liao et al. identified four randomized controlled studies for meta-
REFERENCES
analysis. In total, 110 patients underwent colorectal surgery in the RS group and 116 in the LS group. The results revealed that blood loss, conversion rate and time to recovery of bowel function in the RS group were significantly lower than those in the LS group. There were no significant differences in complication rates, length of hospital stay, proximal margins, distal margins and harvested lymph nodes between the two techniques.4 Based on the review of these meta-analyses, RS for colorectal cancer has a lower conversion rate compared with LS, with no difference in recovery, postoperative and oncological outcomes. In contrast, there are few reports on long-term prognosis of RS for colorectal cancer, although recent survival analysis using propensity score matching shows that the 5-year survival rates of robotic versus laparoscopic resection were 91% versus 78% for overall survival and 73% versus 68% for disease-free survival.5 The ROLARR trial6 is a pan-world, prospective, randomized, controlled, unblinded, superiority trial enrolling over 400 patients to
1. Weber PA, Merola S, Wasielewski A, et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45:1689–96. 2. Trastulli S, Frinella E, Cirocchi R, et al. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and metaanalysis of short-term outcome. Colorectal Dis. 2012;14:e134–56. 3. Lin S, Jiang HG, Chen ZH, et al. Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol. 2011;17:5214–20. 4. Liao G, Zhao Z, Lin S, et al. Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol. 2014;12:122. 5. Kim J, Baek SJ, Kang DW, et al. Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: longterm survival analysis using propensity score matching. Dis Colon Rectum. 2017;60:266–73. 6. Collinson FJ, Jayne DG, Pigazzi A, et al. An international, multicentre, prospective, randomized, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27:233–41.
---------------------------------------------------------------------------------------------------------------------------------------------------------------------This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2017 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery Ann Gastroenterol Surg. 2017;1:75.
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