title: Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches.
abstract: OBJECTIVE
  In recent years, colorectal cancer surgery has benefitted from new techniques such as laparoscopy and robotic surgery. However, many treatment disparities exist among different centers for patients affected by the same kind of tumors.
  
  
  METHODS
  Forty-five (41%) open (OCO) vs. 30 (28%) laparoscopic (LCO) vs. 34 (31%) robotic-assisted (RCO) colectomies and 34 (40%) open (ORR) vs. 52 (60%) robotic (ROR) rectal resections performed during a 15-month period, in elective setting, were compared. Patients presenting contraindications for minimally invasive procedures were excluded from the study, so that all the enrolled patients were suitable for either of the surgical procedures.
  
  
  RESULTS
  Overall morbidity rates were similar among groups. Perioperative mortality was nil. No significant differences were noted as for total number of lymph nodes harvested between arms. Mean time (days) to first bowel movement to gas was 3.3 vs. 2.3 vs. 2.6 for OCO, LCO, and RCO, respectively (p < 0.001), and 3.3 vs. 2.0 for ORR and ROR, respectively (p = 0.003). Among several European Organization in Research and Treatment of Cancer QLQ-C30 functional scales considered only physical functioning was significantly better at 30 days for RCO vs. OCO (96.3 ± 10 RCO vs. 85.5 ± 12.6 OCO; p = 0.015). Robotic surgery was much more expensive in comparison to open as well as laparoscopic procedures.
  
  
  CONCLUSIONS
  Laparoscopic and robotic surgeries for colorectal cancer present both the same advantages in comparison to open procedures in terms of faster recovery. However, our data do not seem to support the routine use of RCO as a cost-effective procedure.
authors.affiliation: Division of General and Laparoscopic Surgery, European Institute of Oncology, Via G. Ripamonti, 435, 20141, Milan, Italy. emilio.bertani@ieo.it
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.forename: Paolo Pietro
authors.initials: PP
authors.lastname: Bianchi
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.forename: Vittorio
authors.initials: V
authors.lastname: Branchi
authors.forename: Elena
authors.initials: E
authors.lastname: Cenderelli
authors.forename: Irene
authors.initials: I
authors.lastname: Vetrano
authors.forename: Sabine
authors.initials: S
authors.lastname: Cenciarelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Andreoni
mesh_terms: D003082:Colectomy / Q000191:economics; D015179:Colorectal Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery; D008875:Middle Aged; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome