Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients

doi:10.4240/wjgs.v16.i5.1271

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. May 27, 2024; 16(5): 1271-1279
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1271

Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients

Hao Yang, Gang Yang, Wen-Ya Wu, Fang Wang, Xue-Quan Yao, Xiao-Yu Wu

Hao Yang, Gang Yang, Wen-Ya Wu, Fang Wang, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China

Xue-Quan Yao, Xiao-Yu Wu, Department of Surgical Oncology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China

Co-corresponding authors: Xue-Quan Yao and Xiao-Yu Wu.

Author contributions: Yang H, Yang G, Wu WY, Wang F, Yao XQ and Wu XY designed the research; Yang H, Yang G, Wu WY and Wang F performed the research; Yang H, Yang G and Wu WY contributed analytic tools and analyzed the data; Yang H, Yao XQ and Wu XY wrote the manuscript; Yao XQ and Wu XY provided help with project funding; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Yao XQ and Wu XY contributed equally to this work as co-corresponding authors. The reasons for designating Yao XQ and Wu XY as co-corresponding authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, Yao XQ and Wu XY contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Yao XQ and Wu XY as co-corresponding authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.

Supported by National Natural Science Foundation of China, NO. 82174466.

Institutional review board statement: The Affiliated Hospital of Nanjing University of Chinese Medicine Institutional Review Board has agreed to change the study to be exempted from ethical review.

Informed consent statement: This was a retrospective study, and the processes of data collection, data analysis, and paper writing did not disclose patients' private information; therefore, no informed consent was obtained.

Conflict-of-interest statement: There are no conflicts of interest.

Data sharing statement: All the data and materials used were obtained from the Affiliated Hospital of Nanjing University of Chinese Medicine.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Xiao-Yu Wu, MD, Professor, Chief Doctor, Chief Physician, Department of Surgical Oncology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. wuxiaoyu@medmail.com.cn

Received: October 31, 2023
Revised: February 5, 2024
Accepted: April 8, 2024
Published online: May 27, 2024
Processing time: 204 Days and 20.3 Hours

Abstract

BACKGROUND

Da Vinci Robotics-assisted total mesorectal excision (TME) surgery for rectal cancer is becoming more widely used. There is no strong evidence that robotic-assisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.

AIM

To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.

METHODS

A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023. The patients were divided into a robot-assisted group (the R-TME group) and a laparoscopic group (the L-TME group), and the short-term efficacy of the two groups was compared.

RESULTS

There were 45 elderly patients (≥ 60 years) in the R-TME group and 50 elderly patients (≥ 60 years) in the L-TME group. There were no differences in demographics, conversion rates, or postoperative complication rates. The L-TME group had a longer surgical time than the R-TME group [145 (125, 187.5) vs 180 (148.75, 206.25) min, P = 0.005), and the first postoperative meal time in the L-TME group was longer than that in the R-TME (4 vs 3 d, P = 0.048). Among the sex and body mass index (BMI) subgroups, the R-TME group had better outcomes than did the L-TME group in terms of operation time (P = 0.042) and intraoperative assessment of bleeding (P = 0.042). In the high BMI group, catheter removal occurred earlier in the R-TME group than in the L-TME group (3 vs 4 d, P = 0.001), and autonomous voiding function was restored.

CONCLUSION

The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery; however, robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis. Optimizing the learning curve can shorten the operation time, reduce the recovery time of gastrointestinal function, and improve the prognosis.

Keywords: Robotic surgery; Laparoscopy; Rectal cancer; Total mesorectal excision; Elderly

Core Tip: Previous studies have shown that laparoscopic total mesorectal excision (TME) surgery for rectal cancer has been widely used worldwide. Robotic-assisted systems are capable of achieving finer anatomical manipulation and better surgical outcomes with high-definition cameras, but TME surgery has not been widely promoted in elderly rectal cancer patients. In this retrospective study, we enrich the evidence that robotic-assisted systems deserve to be widely used over laparoscopy.