Can robotic rectal cancer surgery improve quality of total mesorectal excision?
Authors:
D. Langer 1; I. Tučková 2; J. Kalvach 1; M. Ryska 1
Authors place of work:
Chirurgická klinika 2. LF Univerzity Karlovy a ÚVN, Praha
přednosta: prof. MUDr. M. Ryska, CSc.
1; Oddělení patologie ÚVN – Vojenská fakultní nemocnice Praha
primář: MUDr. P. Hrabal
2
Published in the journal:
Rozhl. Chir., 2017, roč. 96, č. 2, s. 69-74.
Category:
Original articles
Summary
Introduction:
The introduction of total mesorectal excision (TME) in the 1980s was pivotal in the surgical treatment for rectal carcinoma (RC). Routinely applied TME led to a significant reduction in the incidence of local recurrences. The purpose of our paper is to present the results of our non-randomized study comparing prospectively acquired data from radical resection / rectal extirpation using classic open access, laparoscopy and da Vinci robotic system.
Method:
The study group included 116 patients with RC who underwent radical surgical treatment between 1/2014–12/2016, after which the collected resection specimens were assessed in pathology laboratories of the referring hospital using the Quirke’s protocol. Analysis of data collected prospectively over a period of 3 years was done. The surgical procedures were open, laparoscopic and robotic. Robotic surgery could only be performed in patients whose health insurers guaranteed to cover the robotic resection expenses. Those patients whose health insurers did not cover the costs of the robotic assisted procedure were treated using the laparoscopic technique.
Results:
Over a period of 3 years (2014–2016), the teams at the Department of Surgery of the 2nd Faculty of Medicine, Charles University and Central Military Hospital, Prague treated 116 patients (75 men and 41 women) for RC; resected specimens of the patients were processed according to the Quirke’s protocol. Mean age was 63 years (33–80). pCRO positivity was confirmed in 5 patients (4.3%) and complete or nearly complete TME was achieved in 94 patients (81%). More than a half of the procedures were performed using the minimally invasive surgery. No patient died.
Conclusion:
Despite the high rate of technically difficult cases (male sex, tumours in the distal third of the rectum), the robotic assisted treatment showed best results in our study group in terms of quality of the mesorectal excision. Our results thus provide evidence of an unequivocal benefit of robotic assistance compared to manual laparoscopy and open procedures in terms of TME as a quality indicator of surgery in patients with CR. Given the limited time span, there are no long-term results to be assessed in our patients.
Key words:
rectal carcinoma – TME – evaluation of surgical treatment – robotic rectal surgery
Zdroje
1. Heald RJ, Husband EM, Ryal RD. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg 1982;69:613−6.
2. Kapiteijn E, Putter H, van de Velde CJ. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 2002;89:1142−9.
3. How P, Shihab O, Tekkis P, et al. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011;20:149−55.
4. Ferko A, Örhalmi J, Nikolov DH, et al. Radikalita resekční léčby pro karcinom rekta (Analýza prediktivních faktorů spojených s nekompletní mezorektální excizí.) Rozhl Chir 2013;92:12−8.
5. Hovorková E, Hadži ND, Ferko A, et al. Problematika stanovení bezpečných resekčních okrajů u karcinomu rekta. Rozhl Chir 2014,93;2:92−9.
6. Langer D, Kalvach J, Tučková I, et al. Da Vinci asistovaná léčba karcinomu rekta - průběžné výsledky nerandomizované studie. Rozhl Chir 2015;94:526−30.
7. Quirke P, Steele R, Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 2009;373:821−8.
8. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26:303−12.
9. MERCURY study group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 2007;243:132−9.
10. Hoch J, Ferko A, Blaha M, et al. Parametrické sledování kvality totální mezorektální excize a chirurgické léčby karcinomu rekta – výsledky multicentrické studie. Rozhl Chir 2016;95:262−71.
11. Nagtegaal ID, van de Velde CJ, van der Worp E, et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 2002;20:1729−34.
12. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365:1718−26.
13. Kang SB, Park JW, Jeong SY, et al. 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 2010;11:637−45.
14. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013;14:210−8.
15. Nelson H, Petreli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583−96.
16. Stevenson AR, Solomon MJ, Lumley JW, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: The ALaCaRT randomized clinical trial. JAMA 2015;314:1356−63.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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