The impact of robotic total mesorectal excision on survival of patients with rectal cancer—a propensity matched analysis

P. Tejedor, F. Sagias, K. Flashman, Yeh Han Lee, S. Naqvi, N. Kandala, Jim Khan

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Abstract

Introduction: Robotic surgery can overcome some limitations of laparoscopic total mesorectal excision (L-TME), improving the quality of the surgery. We aim to compare the medium-term oncological outcomes of L-TME vs. robotic total mesorectal excision (R-TME) for rectal cancer.

Methods: A retrospective analysis was performed including patients who underwent L-TME or R-TME between 2011 and 2017. Patients presenting with metastatic disease or R1 resection were excluded. From a total of 680 patients, 136 cases of R-TME were matched based on age, gender, stage and time of follow-up with an equal number of patients who underwent L-TME. We compared 3-year disease-free survival (DFS) and overall survival (OS).

Results: Major complications were lower in the robotic group (13.2% vs. 22.8%, p = 0.04), highlighting the anastomotic leakage rate (7.4% vs. 16.9%, p = 0.01).

The 3-year DFS rate for all stages was 69% for L-TME and 84% for R-TME (p = 0.02). For disease stage III, the 3-year DFS was significantly higher in the R-TME group. OS was also significantly superior in the robotic group for every stage, reaching 86% in stage III.

In the multivariate analysis, R-TME was a significant positive prognostic factor for distant metastasis (OR 0.2 95% CI 0.1, 0.6, p = 0.001) and OS (OR 0.2 95% CI 0.07, 0.4, p = 0.000). Moreover, major complications were also found to have a negative impact on OS (OR 8.3 95% CI 3.2, 21.6, p = 0.000).

Conclusion: R-TME for rectal cancer can achieve better oncological outcomes compared with L-TME, especially in stage III rectal cancers. However, a longer follow-up period is needed to confirm these findings.
Original languageEnglish
Pages (from-to)2081-2089
Number of pages9
JournalInternational Journal of Colorectal Disease
Volume34
Issue number12
Early online date11 Nov 2019
DOIs
Publication statusPublished - 1 Dec 2019

Keywords

  • robotic surgery
  • laparoscopic surgery
  • rectal cancer
  • oncologic outcome
  • total mesorectal excision
  • survival

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