title: Oncologic and Clinicopathologic Outcomes of Robot-Assisted Total Mesorectal Excision for Rectal Cancer.
abstract: BACKGROUND
  Minimally invasive rectal cancer surgery is challenging and technically difficult. Robotic technology offers a stable surgical platform with magnified 3-dimensional vision and endowristed instruments, which may facilitate the minimally invasive procedure. Data on short-term and long-term outcomes indicate results comparable to laparoscopic and open surgery.
  
  
  OBJECTIVE
  We assessed the perioperative, clinicopathologic, and oncologic outcomes of robotic surgery for rectal cancer.
  
  
  METHODS
  This study was a review of a prospective database of patients over a 7-year period.
  
  
  METHODS
  Procedures took place in the colorectal division at a tertiary hospital.
  
  
  METHODS
  From August 2005 to October 2012, 101 patients with rectal cancer were operated on using the robotic approach. Rectal cancers were defined as tumors within 15 cm from the anal verge.
  
  
  METHODS
  Patients received either a totally robotic or a hybrid laparoscopic-robotic operation with rectal dissection performed robotically.
  
  
  METHODS
  Operative and perioperative data, pathologic outcomes, and disease-free and overall survival were examined.
  
  
  RESULTS
  There were 63 men (62.4%) and 38 women (37.6%) in the study; the mean age was 61.5 years. Mid rectal and low rectal cancers composed 74.2% of cases. Preoperative chemoradiation was given to 74.3% of patients. Four conversions to open surgery occurred. Circumferential margin positivity was 5%, and median lymph node yield was 15. At a mean follow-up of 34.9 months, the disease-free survival was 79.2% and overall survival 90.1%. The mean cost of robotic surgery was $22,640 versus $18,330 for the hand-assisted laparoscopic approach (p = 0.005).
  
  
  CONCLUSIONS
  This was a single-institution study with no head-to-head comparative group.
  
  
  CONCLUSIONS
  Robotic surgery for rectal cancer extirpation is safe and feasible. It has a low conversion rate, satisfies all measures of pathologic adequacy, and offers acceptable oncologic outcomes. Robotic surgery is significantly more expensive than hand-assisted laparoscopic surgery. The absence of randomized data limits recommending it as the standard of care at present.
authors.affiliation: 1 Advocate Lutheran General Hospital, Park Ridge, Illinois 2 University of Illinois at Chicago, College of Medicine, Chicago, Illinois 3 Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, Illinois 4 James R. and Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Ajit
authors.initials: A
authors.lastname: Pai
authors.forename: Slawomir J
authors.initials: SJ
authors.lastname: Marecik
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.forename: George
authors.initials: G
authors.lastname: Melich
authors.forename: Suela
authors.initials: S
authors.lastname: Sulo
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome