Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study

Robotic total mesorectal excision (RTME), a novel approach for the treatment of rectal cancer, has been shown in previous studies to be safe and effective. However, the results of this approach compared with laparoscopic total mesorectal excision (LTME) have not been reported in terms of clinical outcome and oncologic data. This study compared early outcomes for rectal cancer between two groups.

Between April 2003 and March 2009, 82 patients from a prospectively maintained database were enrolled in a case-matched study. The patients were matched for gender, age, body mass index (BMI), and type of operative procedure.

Neoadjuvant chemoradiotherapy was performed for 33 RTME patients (80.5%) and 18 LTME patients (43.9%) (p=0.001). The mean operative time was 296 min for RTME and 315 min for LTME (p=0.357). The number of conversions were 3 (7.3%) for RTME and 9 (22%) for LTME (p=0.12). The anastomotic leak rate after surgery did not differ between RTME (n=3, 8.6%) and LTME (n=1, 2.9%) (p=0.62). The mean number of harvested lymph nodes was 13.1 with RTME and 16.2 with LTME (p=0.07), and negative distal resection margins (DRMs) were noted in all surgical specimens. Positive circumferential resections (CRMs) were identified in 2.4% of the RTME cases and 4.9% of the LTME cases. No difference was noted in lengths of the DRMs, times until a liquid diet, or postoperative hospital stays. The total hospitalization costs were higher in the RTME group, although the difference did not reach statistical significance. There was no operative mortality or port-site recurrence in either group.

For rectal cancer, RTME may be as feasible and safe as LTME in terms of technical and oncologic issues. Further prospective randomized trials are necessary for conclusions to be drawn concerning definite oncologic outcomes of robotic procedures for rectal cancer.