113 Does Robotic Anterior Resection Improve the Outcomes for Patients with Rectal Cancer Over Standard Laparoscopic Surgery?

Background

Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS).

Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS.

Aim

To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness.

Method

A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database.

141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review.

Results

Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p = 0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p = 0.03, 0.0001<, 0.001<, 0.001). Overall, R-AR had lower rates of intraoperative complications.

Conclusions

Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.