Robotic Versus Laparoscopic Partial Mesorectal Excision for Cancer of the High Rectum: A Single-Center Study with Propen
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ORIGINAL SCIENTIFIC REPORT
Robotic Versus Laparoscopic Partial Mesorectal Excision for Cancer of the High Rectum: A Single-Center Study with Propensity Score Matching Analysis Nicola de’Angelis1,2 • Margerita Notarnicola1 • Aleix Martı´nez-Pe´rez3 • Riccardo Memeo4 • Cecile Charpy5 • Irene Urciuoli1 • Fabio Maroso1 • Daniele Sommacale1 • Aurelien Amiot2,6 • Florence Canouı¨-Poitrine7,8 • Eric Levesque9 Francesco Brunetti1
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (RPME) versus laparoscopic (L-PME) PME for high RC. Methods This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum ([10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019. Results Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PME patients, except for operative time (220 min and 190 min, respectively; p \ 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME. Conclusion Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon’s experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05666-0) contains supplementary material, which is available to authorized users. & Nicola de’Angelis [email protected] 1
2
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Mare´chal de Lattre de Tassigny, 94010 Cre´teil, France EA7375 (EC2M3 Research Team), Universite´ Paris Est, 51 Avenue du Mare´chal de Lattre de Tassigny, 94000 Cre´teil, France
3
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, 90, Av. de Gaspar Aguilar, 46017 Valencia, Spain
4
Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Piazza Umberto I, 1, 70121 Bari, Italy
5
Department of Pathology, Henri Mondor Hospital, AP-HP, 51 Avenue du Mare´chal de Lattre de Tassigny, 94010 Cre´teil, Fr
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