Robotic versus laparoscopic surgery in colon and rectal cancer

Jae-Won Shin; Seon-Hahn Kim

doi:10.5124/jkma.2012.55.7.620

Journal List > J Korean Med Assoc > v.55(7) > 1042589

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Shin and Kim: Robotic versus laparoscopic surgery in colon and rectal cancer

Focused Issue of This Month

Current Status of Robotic Surgery

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(7): 620-628.

Published online: 11 July 2012

DOI: https://doi.org/10.5124/jkma.2012.55.7.620

Robotic versus laparoscopic surgery in colon and rectal cancer

Jae-Won Shin, MD, Seon-Hahn Kim, MD

Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Seon-Hahn Kim, drkimsh@korea.ac.kr

Received 8 June 2012 Accepted 22 June 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Laparoscopic surgery is an acceptable option for colorectal cancer. Robotic surgery is an emerging methodology and may be a solution to some difficulties inherent to conventional laparoscopic surgery. The aims of this study are to review the outcomes of laparoscopic and robotic surgery, and to discuss robotic surgery from the perspective of treating colorectal cancer. In rectal cancer, robotic surgery takes a longer operative time and has a higher cost, but decreases conversion to open surgery and shortens the learning curve. It has a great potential for preserving bladder and sexual function after total mesorectal excision (TME). The TME quality may also be better. Robotic surgery can also modify the current standard anastomosis following rectal resection, which is a double-stapling technique. Using a robot enables transanal specimen retrieval then a single-circular stapled anastomosis, which is associated with low pain and fast recovery. More solid answers including the long-term oncologic safety will be provided by ongoing randomized trials. In colon cancer, the ease of performing intracorporeal suture anastomosis may be a benefit. Since complete mesocolic excision with wide lymphadenectomy is becoming more and more acceptable to achieve better oncologic outcomes, the role of robotic surgery in providing a stable environment for radically dissecting lymph nodes should be evaluated. Recently developed new technologies such as fluorescent imaging and a robotic stapler seem promising potentially providing further benefits such as a decrease in anastomotic leakage. Single port robotic surgery is also an interesting concept requiring clinical evaluation. Robotic surgery is a developing field and may provide further functional and oncological benefits to colorectal cancer patients. Large scale randomized trials are timely important.

Keywords: Colorectal surgery, Robotic surgery, Laparoscopy

Figures and Tables

Table 1

Demographics of the studies which we used in this analysis

Lap, laparoscopic surgery; Ro, robotic surgery.

Table 2

Comparison of operative outcomes between robotic and laparoscopic resection for rectal cancer

Lap, laparoscopic surgery; Ro, robotic surgery; LAR, low anterior resection; OT, operation time; NS, no statistical difference; EBL, estimated blood loss; LN, count of harvested lymph nodes; DRM, length of distal resection margin; HS, days of hospital stay; Con, conversion rate; SD, able to permit soft diet; ISR, intershpincteric resection; APR, abdominoperineal resection; CRM, positivity of circumferential resection margin.

^*P<0.05.

Table 3

Comparison of operative outcomes between robotic and laparoscopic resection for colon cancer

Lap, laparoscopic surgery; Ro, robotic surgery; EBL, estimated blood loss; NA, not available.

^*P<0.05.

Table 4

Comparison of costs between robotic and laparoscopic resection for colorectal cancer

Lap, laparoscopic surgery; Ro, robotic surgery; OR, operating room; NA, not available.

^*P<0.05.

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