Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1280-1290
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1280
Robotic vs laparoscopic abdominoperineal resection for rectal cancer: A propensity score matching cohort study and meta-analysis
Li Song, Wen-Qiong Xu, Zheng-Qiang Wei, Gang Tang
Li Song, Department of Gastrointestinal Surgery, Chengdu Fifth People's Hospital, Chengdu 610000, Sichuan Province, China
Wen-Qiong Xu, Department of Nephrology, Chengdu Fifth People's Hospital, Chengdu 610000, Sichuan Province, China
Zheng-Qiang Wei, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Gang Tang, Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Song L, Xu WQ, Wei ZQ, and Tang G made substantial contributions to conception and design; Xu WQ, Wei ZQ, and Tang G contributed to the acquisition of data, analysis, and interpretation; Song L and Tang G wrote the manuscript; Song L, Xu WQ, Wei ZQ, and Tang G supervised the work and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Chongqing Medical University Institutional Review Board (Approval No. 2022-K533).
Informed consent statement: Considering that the research was retrospective, the need for patients’ informed written consent was waived.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at gangtang2017@163.com.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Tang, MD, Doctor, Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. gangtang2017@163.com
Received: December 6, 2023
Revised: February 29, 2024
Accepted: April 10, 2024
Published online: May 27, 2024
Processing time: 169 Days and 8.1 Hours
Abstract
BACKGROUND

Robotic surgery (RS) is gaining popularity; however, evidence for abdominoperineal resection (APR) of rectal cancer (RC) is scarce.

AIM

To compare the efficacy of RS and laparoscopic surgery (LS) in APR for RC.

METHODS

We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022. Data regarding short-term surgical outcomes were compared between the two groups. To reduce the effect of potential confounding factors, propensity score matching was used, with a 1:1 ratio between the RS and LS groups. A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.

RESULTS

Of 133 patients, after propensity score matching, there were 42 patients in each group. The postoperative complication rate was significantly lower in the RS group (17/42, 40.5%) than in the LS group (27/42, 64.3%) (P = 0.029). There was no significant difference in operative time (P = 0.564), intraoperative transfusion (P = 0.314), reoperation rate (P = 0.314), lymph nodes harvested (P = 0.309), or circumferential resection margin (CRM) positive rate (P = 0.314) between the two groups. The meta-analysis showed patients in the RS group had fewer positive CRMs (P = 0.04), lesser estimated blood loss (P < 0.00001), shorter postoperative hospital stays (P = 0.02), and fewer postoperative complications (P = 0.002) than patients in the LS group.

CONCLUSION

Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.

Keywords: Robotic surgery, Laparoscopic surgery, Abdominoperineal resection, Postoperative complications, Propensity score

Core Tip: This study compared the efficacy of robotic surgery (RS) and laparoscopic surgery (LS) in abdominoperineal resection (APR) for rectal cancer (RC). Our results showed that RS patients had fewer positive circumferential resection margins, less estimated blood loss, shorter postoperative hospital stays, and fewer postoperative complications than did LS patients. Our findings demonstrate that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS. This study contributes to the existing evidence base and can assist surgeons and healthcare providers in making informed decisions on using RS in APR for RC.