Robotic Versus Laparoscopic Surgery for Rectal Cancer after Preoperative Chemoradiotherapy: Case-Matched Study of Short-Term Outcomes
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Purpose Robotic surgery is expected to have advantages over laparoscopic surgery; however, there are limited data regarding the feasibility of robotic surgery for rectal cancer after preoperative chemoradiotherapy (CRT). Therefore, we evaluated the short-term outcomes of robotic sur- gery for rectal cancer. Materials and Methods Thirty-three patients with cT3N0-2 rectal cancer after preoperative CRT who underwent robotic low anterior resection (R-LAR) between March 2010 and January 2012 were matched with 66 patients undergoing laparoscopic low anterior resection (L-LAR). Periop- erative clinical outcomes and pathological data were compared between the two groups. Results Patient characteristics did not differ significantly different between groups. The mean oper- ation time was 441 minutes (R-LAR) versus 277 minutes (L-LAR, p < 0.001). The open con- version rate was 6.1% in the R-LAR group and 0% in the L-LAR group (p=0.11). There were no significant differences in the time to flatus passage, length of hospital stay, and postop- erative morbidity. In pathological review, the mean number of harvested lymph nodes was 22.3 in R-LAR and 21.6 in L-LAR (p=0.82). Involvement of circumferential resection margin was positive in 16.1% and 6.7%, respectively (p=0.42). Total mesorectal excision (TME) quality was complete in 97.0% in R-LAR and 91.0% in L-LAR (p=0.41). Conclusion In our study, short-term outcomes of robotic surgery for rectal cancer after CRT were similar to those of laparoscopic surgery in respect to bowel function recovery, morbidity, and TME quality. Well-designed clinical trials are needed to evaluate the functional results and long- term outcomes of robotic surgery for rectal cancer.
Abstract
Purpose Robotic surgery is expected to have advantages over laparoscopic surgery; however, there are limited data regarding the feasibility of robotic surgery for rectal cancer after preoperative chemoradiotherapy (CRT). Therefore, we evaluated the short-term outcomes of robotic sur- gery for rectal cancer. Materials and Methods Thirty-three patients with cT3N0-2 rectal cancer after preoperative CRT who underwent robotic low anterior resection (R-LAR) between March 2010 and January 2012 were matched with 66 patients undergoing laparoscopic low anterior resection (L-LAR). Periop- erative clinical outcomes and pathological data were compared between the two groups. Results Patient characteristics did not differ significantly different between groups. The mean oper- ation time was 441 minutes (R-LAR) versus 277 minutes (L-LAR, p < 0.001). The open con- version rate was 6.1% in the R-LAR group and 0% in the L-LAR group (p=0.11). There were no significant differences in the time to flatus passage, length of hospital stay, and postop- erative morbidity. In pathological review, the mean number of harvested lymph nodes was 22.3 in R-LAR and 21.6 in L-LAR (p=0.82). Involvement of circumferential resection margin was positive in 16.1% and 6.7%, respectively (p=0.42). Total mesorectal excision (TME) quality was complete in 97.0% in R-LAR and 91.0% in L-LAR (p=0.41). Conclusion In our study, short-term outcomes of robotic surgery for rectal cancer after CRT were similar to those of laparoscopic surgery in respect to bowel function recovery, morbidity, and TME quality. Well-designed clinical trials are needed to evaluate the functional results and long- term outcomes of robotic surgery for rectal cancer.
참고문헌 (24)
- Clinical Outcomes of Surgical Therapy Study Group, "A comparison of laparoscopically assisted and open colectomy for colon cancer", N Engl J Med, 350, pp.2050~2059 (2004)
- Guillou PJ, "Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer(MRC CLASICC trial) : multicentre, randomised controlled trial", Lancet, 365, pp.1718~1726 (2005)
- Veldkamp R, "Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomised trial", Lancet Oncol, 6, pp.477~484 (2005)
- Kang SB, "Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial):short-term outcomes of an open-label randomised controlled trial", Lancet Oncol, 11, pp.637~645 (2010)
- Sammour T, "Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery", Ann Surg, 253, pp.35~43 (2011)
- deSouza AL, "Total mesorectal excision for rectal cancer : the potential advantage of robotic assistance", Dis Colon Rectum, 53, pp.1611~1617 (2010)
- Corcione F, "Advantages and limits of robot-assisted laparoscopic surgery : preliminary experience", Surg Endosc, 19, pp.117~119 (2005)
- Bianchi PP, "Robotic versus laparoscopic total mesorectal excision for rectal cancer : a comparative analysis of oncological safety and short-term outcomes", Surg Endosc, 24, pp.2888~2894 (2010)
- Fernandez R, "Laparoscopic versus robotic rectal resection for rectal cancer in a veteran population", Am J Surg, 206, pp.509~517 (2013)
- Kwak JM, "Robotic vs laparoscopic resection of rectal cancer : short-term outcomes of a case-control study", Dis Colon Rectum, 54, pp.151~156 (2011)
- Park JS, "Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes", Ann Surg Oncol, 17, pp.3195~3202 (2010)
- Lim DR, "Robotic versus laparoscopic anterior resection of sigmoid colon cancer : comparative study of long-term oncologic outcomes", Surg Endosc, 27, pp.1379~1385 (2013)
- Baik SH, "Robotic versus laparoscopic low anterior resection of rectal cancer : short-term outcome of a prospective comparative study", Ann Surg Oncol, 16, pp.1480~1487 (2009)
- Dworak O, "Pathological features of rectal cancer after preoperative radiochemotherapy", Int J Colorectal Dis, 12, pp.19~23 (1997)
- Yeo SG, "Preoperative short-course concurrent chemoradiation therapy followed by delayed surgery for locally advanced rectal cancer: a phase 2 multicenter study (KROG 10-01)", Int J Radiat Oncol Biol Phys, 86, pp.34~39 (2013)
- Nagtegaal ID, "Macroscopic evaluation of rectal cancer resection specimen : clinical significance of the pathologist in quality control", J Clin Oncol, 20, pp.1729~1734 (2002)
- Choi DJ, "Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients", Dis Colon Rectum, 52, pp.1824~1830 (2009)
- Baek JH, "Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer", Ann Surg, 251, pp.882~886 (2010)
- 김남규, "Optimal Total Mesorectal Excision for Rectal Cancer: the Role of Robotic Surgery from an Expert’s View", Annals of Coloproctolgy, 26(6), pp.377~387 (2010), 대한대장항문학회
- Baek JH, "Robotic and laparoscopic total mesorectal excision for rectal cancer : a case-matched study", Surg Endosc, 25, pp.521~525 (2011)
- Sng KK, "The multiphasic learning curve for robot-assisted rectal surgery", Surg Endosc, 27, pp.3297~3307 (2013)
- Jimenez-Rodriguez RM, "Learning curve for robotic-assisted laparoscopic rectal cancer surgery", Int J Colorectal Dis, 28, pp.815~821 (2013)
- Patriti A, "Short-and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection", JSLS, 13, pp.176~183 (2009)
- Memon S, "Robotic versus laparoscopic proctectomy for rectal cancer : a meta-analysis", Ann Surg Oncol, 19, pp.2095~2101 (2012)