The following is a summary of “Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers,” published in the June 2023 issue of Surgery by Park et al.
To assess the efficacy of robotic surgery versus laparoscopic surgery in a randomized controlled trial (RCT) for treating middle or low rectal cancer to determine any potential enhancements in surgical outcomes. In the context of multicenter RCTs, the clinical efficacy of robotic total mesorectal excision (TME) compared to a laparoscopic approach has not been conclusively established. Between July 2011 and February 2016, individuals diagnosed with an adenocarcinoma situated less than 10 centimeters from the anal verge and clinically classified as T1-4aNxM0 were included in the study.
The main objective was to evaluate the extent of TME as a surgeon and a pathologist determined. The RCT was terminated prematurely due to inadequate accumulation of data. In total, 295 patients were randomly allocated to either a group receiving robot-assisted total mesorectal excision (151 patients in the R-TME group) or a group receiving laparoscopy-assisted total mesorectal excision (144 patients in the L-TME group). The complete TME rates were not statistically different between the groups, with 80.7% in the right TME group and 77.1% in the left TME group. The pathological outcomes, such as the circumferential resection margin and the number of retrieved lymph nodes, showed no significant differences between the groups. In a sub-analysis, the positive circumferential resection margin rate was lower in the group that underwent radiotherapy-assisted total mesorectal excision (R-TME) compared to the group that underwent laparoscopic-assisted total mesorectal excision (L-TME) (0% vs 6.1% for L-TME; P=0.031).
Among the recovery parameters, the duration of opioid utilization was shorter in the R-TME group (P=0.028). There was no disparity observed in the postoperative complication rate among the groups (12.0% for right total mesorectal excision [R-TME] versus 8.3% for left complete mesorectal excision [L-TME]). In individuals diagnosed with middle or low rectal cancer, the utilization of robotic-assisted surgery did not yield a statistically significant enhancement in the quality of total mesorectal excision (TME) when compared to conventional laparoscopic surgery (ClinicalTrial.gov ID: NCT01042743).
