Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes.
OBJECTIVE
Minimal invasive surgery for mid and low rectal cancer after neoadjuvant long-course chemoradiotherapy (LCRT) can be challenging. The aim of our study was to compare outcomes of laparoscopic and robotic resections in mid and low rectal cancers after LCRT.


METHODS
Between Jan 2006 and Dec 2010, all patients who underwent robotic or laparoscopic resections for mid and low rectal cancers after LCRT were identified from a prospective database. These patients received treatment (5FU-based chemotherapy, 50.4 Gy radiotherapy), as they were T3 or T4 and/or node + ve. Patients in the two groups were compared with respect to demographics, clinical safety, and oncological outcomes.


RESULTS
One hundred thirty-eight patients underwent rectal cancer resection after LCRT, either robotic (n = 74) or laparoscopic (n = 64). The patients in both groups were comparable in terms of demographics, distance of tumor from anal verge, and type of procedures. There were four (6.3 %) conversions in laparoscopic group and one (1.4 %) in the robotic group (p = 0.183). The morbidity rates in the laparoscopic and robotic group were 26.6 % and 16.2 %, respectively (p = 0.137). With a median follow up of 3 years, the local recurrence in the laparoscopic and robotic group was four (6.3 %) and two (2.7 %), respectively (p = 0.420). The 3-year overall survival rate for laparoscopic and robotic group was 92.1 and 90.0 %, respectively (p = 0.803). The 3-year disease-free survival was also comparable, 78.8 % (laparoscopic) versus 77.7 % (robotic) (p = 0.390).


CONCLUSIONS
With a median follow up of 3 years, robotic surgery for mid and low rectal cancer was associated with oncological outcomes comparable to laparoscopic surgery.
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Avanish P
AP
Saklani
Dae Ro
DR
Lim
Hyuk
H
Hur
Byung Soh
BS
Min
Seung Hyuk
SH
Baik
Kang Young
KY
Lee
Nam Kyu
NK
Kim
D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome