Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1558-1570
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1558
Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study
Shen-Xiang Long, Xin-Ning Wang, Shu-Bo Tian, Yu-Fang Bi, Shen-Shuo Gao, Yu Wang, Xiao-Bo Guo
Shen-Xiang Long, Shu-Bo Tian, Yu Wang, Xiao-Bo Guo, Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Xin-Ning Wang, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Yu-Fang Bi, Department of Nursing, The People’s Hospital of Zhangqiu Area, Jinan 250200, Shandong Province, China
Shen-Shuo Gao, Medical Center for Gastrointestinal Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
Co-first authors: Shen-Xiang Long and Xin-Ning Wang.
Author contributions: Long SX and Wang XN contributed equally to this work and should be considered as co-first authors; Long SX and Guo XB contributed to the manuscript writing; Long SX and Wang XN conceived of the presented idea and researched the background of the study; Long SX, Wang XN, and Wang Y contributed to the data collection; Long SX, Wang XN, Bi YF, and Gao SS contributed to the data analysis; Tian SB and Guo XB contributed to the clinical treatment and manuscript modification; and all the authors contributed to the manuscript and approved the submitted version.
Supported by the National Natural Science Foundation of China, No. 81672379.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University.
Informed consent statement: Informed consent from patients was waived by the ethics committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Bo Guo, PhD, Chief Physician, Professor, Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi, Huaiyin District, Jinan 250021, Shandong Province, China. guo992352@hotmail.com
Received: January 23, 2024
Revised: April 9, 2024
Accepted: April 22, 2024
Published online: June 27, 2024
Processing time: 158 Days and 20.3 Hours
Abstract
BACKGROUND

Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide, necessitating surgical resection as the sole treatment option. Over the years, there has been a growing adoption of minimally invasive surgical techniques such as robotic and laparoscopic approaches. Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques. While previous studies have reported favorable perioperative outcomes for robot-assisted radical resection in rectal cancer patients, further evidence regarding its oncological safety is still warranted.

AIM

To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection (LALAR) procedures.

METHODS

The clinical data of 125 patients who underwent robot-assisted low anterior resection (RALAR) and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed. After performing a 1:1 propensity score matching, the patients were divided into two groups: The RALAR group and the LALAR group (111 cases in each group). Subsequently, a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.

RESULTS

Compared to the LALAR group, the RALAR group exhibited a significantly earlier time to first flatus [2 (2-2) d vs 3 (3-3) d, P = 0.000], as well as a shorter time to first fluid diet [4 (3-4) d vs 5 (4-6) d, P = 0.001]. Additionally, the RALAR group demonstrated reduced postoperative indwelling catheter time [2 (1-3) d vs 4 (3-5) d, P = 0.000] and decreased length of hospital stay after surgery [5 (5-7) d vs 7(6-8) d, P = 0.009]. Moreover, there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group [10777 (10780-11850) dollars vs 10550 (8766-11715) dollars, P = 0.012]. No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups. Furthermore, no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.

CONCLUSION

Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection, while maintaining similar perioperative and 3-year oncological outcomes.

Keywords: Rectal cancer, Robotic surgical procedures, Laparoscopy, Low anterior resection, Clinical efficacy

Core Tip: Robotic surgery is increasingly utilized in the management of rectal cancer. However, only retrospective studies and small-scale clinical trials have reported its perioperative outcomes. In this study, propensity score matching was employed to balance baseline data, thereby enhancing the credibility of the conclusions compared to general retrospective studies. Moreover, it is encouraging that the perioperative results and 3-year oncological outcomes of robotic surgery are similar to those of traditional laparoscopic surgery.