Robotic Approach Better Than Laparoscopic Approach
The treatment of rectal cancer is complex and responsible for sequelae due to the various therapeutic modalities, especially the surgical resection. The advent of minimally invasive surgery provided a faster postoperative recovery and a lower complication rate when compared to conventional surgery. The implementation of laparoscopic approach in rectal cancer was responsible for these better results, but the limitations of this method added to the development of robotics, raised the question of which minimally invasive method would be more advantageous in the approach of rectal cancer. Our paper published on Journal of Coloproctology this year (https://doi.org/10.1016/j.jcol.2019.05.003) addressed the most recent data regarding the comparison between the laparoscopic and robotic approach in rectal cancer. Here we make a mini-review on our previous publication.
Laparoscopic surgery offers the same oncologic results of conventional surgery associated with a faster postoperative recovery. However, although laparoscopic treatment of colon cancer has proven to be feasible and oncologically safe, on the other hand, the treatment of laparoscopic rectal cancer has been less adopted for several reasons: need for a long and arduous learning curve, technical difficulties related to the limitations of the method itself and by the anatomical aspects of the rectal surgery. Therefore, robotic surgery was developed as a new technique capable of overcoming the limitations of laparoscopy in the pelvis and thus making the minimally invasive TME more adoptable and reproducible.
Until 2016 four meta-analysis investigated the role of robotic surgery in rectal cancer compared to the laparoscopic approach. These 4 met analysis were concordant in some aspects: they showed that the robotic approach presented similar results to laparoscopy regarding morbimortality, oncological outcomes of short and medium term, as well as identifying a significantly lower rate of conversion in the robotic group. These 4 met analysis had limitations: the small number of studies published at that time included in the analysis. From 2017 to 2019, three meta-analysis were published addressing this topic. Below we summarize the findings of the most recent meta-analysis mentioned above.
There was no difference in the length of hospital stay between robotics and laparoscopy in the 2 meta-analysis cited. Regarding the return of the intestinal function, Li et al. did not show any difference between the 2 groups. On the other hand, Prete et al. showed an earlier bowel function return in the robotic group (statistically significant different), but the quality of the evidence was considered low. Moreover, Ng and et al. showed that the robotic group had a significantly shorter duration of hospitalization, time to oral diet and lesser intraoperative blood loss.
The rational of the robotic approach in rectal cancer is to overcome the technical difficulties of laparoscopy, provide oncological outcomes similar to those of laparoscopy, but offer better functional results and a lower conversion rate.