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Robotic versus laparoscopic low anterior resection following neoadjuvant chemoradiation therapy for stage II–III locally advanced rectal cancer: a single-centre cohort study

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Abstract

Neoadjuvant chemo-radiotherapy (nCRT) of locally advanced rectal cancer is associated with challenging surgical treatment and increased postoperative morbidity. Robotic technology overcomes laparoscopy limitations by enlarged 3D view, improved anatomical transection accuracy, and physiologic tremor reduction. Patients with UICC stage II–III rectal cancer, consecutively referred to our institution between March 2015 and June 2020 (n = 102) were treated with robotic (Rob-G, n = 38) or laparoscopic (Lap-G, n = 64) low anterior resection (LAR) for total meso-rectal excision (TME) following highly standardized and successful nCRT treatment. Feasibility, conversion rates, stoma creation, morbidity and clinical/pathological outcome were comparatively analysed. Sex, age, BMI, ASA scores, cTN stages and tumour distance from dentate line were comparable in the two groups. Robotic resection was always feasible without conversion to open surgery, which was necessary in 11/64 (17%) Lap-G operations (p = 0.006). Primary or secondary stomata were created in 17/38 (45%) Rob-G and 52/64 (81%) Lap-G patients (p < 0.001). Major morbidity occurred in 7/38 (18.4%) Rob-G and 6/64 (9.3%) Lap-G patients (p = 0.225). Although median operation time was longer in Rob-G compared with Lap-G (376; IQR: 330–417 min vs. 300; IQR: 270–358 min; p < 0.001), the difference was not significant in patients (Rob-G, n = 6; Lap-G, n = 10) with ≥30 BMI (p = 0.106). Number of resected lymph nodes, ypTN staging and circumferential resection margins (CRM) were comparable. Resection was complete in 87% of Rob-G and 89% of Lap-G patients (p = 0.750). Robotic LAR is not inferior to laparoscopic LAR following nCRT. Larger, randomized studies are needed to confirm lower conversion in robotic, compared to laparoscopic resection.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The limitations of this study include its retrospective and non-randomized nature, and the limited sample size. Moreover, involved surgeons were highly experienced with laparoscopic rectal resection but less so with robotic LAR, thus suggesting that they had not fully overcome their learning curve at the beginning of this study [34].

Funding

This study is funded by institutional means.

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Author notes

  1. Fiorenzo V. Angehrn and Romano Schneider contributed equally and share first authorship.

  2. Daniel C. Steinemann and Martin Bolli contributed equally and share senior authorship.

Authors and Affiliations

  1. Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland

    Fiorenzo V. Angehrn, Romano Schneider, Alexander Wilhelm, Diana Daume, Luca Koechlin, Lana Fourie, Markus von Flüe, Beatrice Kern, Daniel C. Steinemann & Martin Bolli

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  1. Fiorenzo V. Angehrn
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Contributions

FVA and RS wrote the main manuscript text, created the tables and figures and collected most of the data. AW was responsible for completing and analysing the follow-up data and writing the related paragraph. DD and LK helped keep the data files current, performed limited data analysis, and reviewed the manuscript. Most reviewing, rewriting and data analyses were achieved by DS. MF, BK and MB were responsible for the study design and coordination, and they reviewed the manuscript.

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Correspondence to Fiorenzo V. Angehrn.

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Angehrn, F.V., Schneider, R., Wilhelm, A. et al. Robotic versus laparoscopic low anterior resection following neoadjuvant chemoradiation therapy for stage II–III locally advanced rectal cancer: a single-centre cohort study. J Robotic Surg 16, 1133–1141 (2022). https://doi.org/10.1007/s11701-021-01351-z

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