Introduction Robotic surgery provides unique potential benefits when performing rectal surgery such as a stable 3D view and precision dissection with wristed instruments and improved access to the pelvis. Previous studies have reported equivalent outcomes to laparoscopic surgery but no benefit has yet been identified. We aimed to review our unselected cohort of rectal cancer resections.
Method Analysis of a prospectively collected database was conducted covering a consecutive five-year period from 2009 to 2014. All patients were treated by one of two robotic surgeons and had a tumour within 15 cm of the anal verge and underwent either robotic or laparoscopic resection. The decision to offer robotic surgery was based on surgeon preference for the individual case and influenced by availability of the robot and in some cases the results of randomization in an international trial. For robotic resections a hybrid technique was employed with laparoscopic abdominal surgery followed by 4-arm robotic rectal mobilisation.
Results 156 cases were analysed, 88 robotic and 68 laparoscopic, with a median follow up of 20 months. There was no significant difference between the groups in terms of gender, BMI, ASA classification, pathological staging or the use of pre-operative long-course chemo-radiotherapy. Robotic patients were significantly younger (65.7 yrs (SD 10.8) vs 69.7 yrs (SD 11.3); p = 0.029). Distance of the tumour from the anal verge was significantly shorter in the robotic group (height (7.7 cm (SD 3.7) vs. 9.2cm (SD 3.6); p = 0.01) and this was reflected in a greater number of abdomino-perineal resections in the robotic versus laparoscopic group (17.0% vs. 7.4% respectively). The rate of conversion to open surgery (defined as any part of the procedure performed open apart from specimen extraction and stapler anvil insertion) was significantly lower in the robotic (11.4%) versus laparoscopic group (39%), p = 0.004, and there was a non-significant trend towards a shorter length of stay in the robotic group (median (IQR): robotic 6(5–9.75) days vs. laparoscopic 7(4.25–11), p = 0.60). There were no significant differences in other short-term outcomes including operative mortality, readmission and circumferential resection margin involvement rates.
Conclusion In this unselected group, robotic surgery for rectal cancer provided equivalent oncological outcomes to laparoscopic surgery and a significantly lower rate of conversion to open surgery, despite lower tumours being treated. There was no difference in short-term adverse events. There may be a benefit in terms of shorter hospital stay and the results of a major international trial are awaited to determine whether there are any potential quality of life benefits.
Disclosure of interest None Declared.