Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2020; 12(4): 424-434
Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.424
Robotic- vs laparoscopic-assisted proctectomy for locally advanced rectal cancer based on propensity score matching: Short-term outcomes at a colorectal center in China
Shan-Ping Ye, Wei-Quan Zhu, Dong-Ning Liu, Xiong Lei, Qun-Guang Jiang, Hui-Min Hu, Bo Tang, Peng-Hui He, Geng-Mei Gao, He-Chun Tang, Jun Shi, Tai-Yuan Li
Shan-Ping Ye, Wei-Quan Zhu, Dong-Ning Liu, Xiong Lei, Qun-Guang Jiang, Bo Tang, Peng-Hui He, Geng-Mei Gao, He-Chun Tang, Jun Shi, Tai-Yuan Li, Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Shan-Ping Ye, Wei-Quan Zhu, Hui-Min Hu, Bo Tang, Geng-Mei Gao, He-Chun Tang, Department of Graduate Student, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Ye SP and Li TY designed the research; Ye SP, Zhu WQ, He PH, Gao GM, Tang HC, and Hu HM collected data and conducted the analysis of pooled data; Ye SP, Lei X and Liu DN helped to draft the manuscript; Ye SP, Jiang QG and Tang B wrote the manuscript; Ye SP and Shi J proofread and revised the manuscript; all authors have approved the version to be published.
Supported by the Infrastructure Supporting Project of Jiangxi Scientific Research Institute, No. 20142BBA13039.
Institutional review board statement: The current study was approved by the institutional review board of our hospital (2016-050) and complies with the Helsinki Declaration.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: Access to the database can be obtained from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tai-Yuan Li, MD, PhD, Chief Doctor, Director, Professor, Department of General Surgery, First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. litaiyuanyfy@sina.com
Received: December 11, 2019
Peer-review started: December 11, 2019
First decision: December 26, 2019
Revised: December 28, 2019
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 15, 2020
Abstract
BACKGROUND

Reports in the field of robotic surgery for rectal cancer are increasing year by year. However, most of these studies enroll patients at a relatively early stage and have small sample sizes. In fact, studies only on patients with locally advanced rectal cancer (LARC) and with relatively large sample sizes are lacking.

AIM

To investigate whether the short-term outcomes differed between robotic-assisted proctectomy (RAP) and laparoscopic-assisted proctectomy (LAP) for LARC.

METHODS

The clinicopathological data of patients with LARC who underwent robotic- or laparoscopic-assisted radical surgery between January 2015 and October 2019 were collected retrospectively. To reduce patient selection bias, we used the clinical baseline characteristics of the two groups of patients as covariates for propensity-score matching (PSM) analysis. Short-term outcomes were compared between the two groups.

RESULTS

The clinical features were well matched in the PSM cohort. Compared with the LAP group, the RAP group had less intraoperative blood loss, lower volume of pelvic cavity drainage, less time to remove the pelvic drainage tube and urinary catheter, longer distal resection margin and lower rates of conversion (P < 0.05). However, the time to recover bowel function, the harvested lymph nodes, the postoperative length of hospital stay, and the rate of unplanned readmission within 30 days postoperatively showed no difference between the two groups (P > 0.05). The rates of total complications and all individual complications were similar between the RAP and LAP groups (P > 0.05).

CONCLUSION

This retrospective study indicated that RAP is a safe and feasible method for LARC with better short-term outcomes than LAP, but we have to admit that the clinically significant of part of indicators are relatively small in the practical situation.

Keywords: Rectal neoplasms, Robotics, Laparoscopy, Proctectomy, Treatment outcome

Core tip: For patients with locally advanced rectal cancer, there is no consensus regarding whether robotic-assisted proctectomy and laparoscopic-assisted proctectomy is more beneficial. We conducted this retrospective cohort study to compare the short-term outcomes of robotic and laparoscopic for the rectal surgery. Compared with the laparoscopic-assisted proctectomy group, the robotic-assisted proctectomy group had less intraoperative blood loss, lower volume of pelvic cavity drainage, less time to remove the pelvic drainage tube and urinary catheter, longer distal resection margin and lower rates of conversion. Furthermore, the time to recover bowel function, the harvested lymph nodes, the postoperative length of hospital stay, the rate of unplanned readmission within 30 d postoperatively, and the rates of total complications showed no difference between the two groups.