Robotic Versus Laparoscopic Partial Mesorectal Excision for Cancer of the High Rectum: A Single-Center Study with Propensity Score Matching Analysis
Por:
de'Angelis N, Notarnicola M, Martínez-Pérez A, Memeo R, Charpy C, Urciuoli I, Maroso F, Sommacale D, Amiot A, Canouï-Poitrine F, Levesque E and Brunetti F
Publicada:
1 nov 2020
Ahead of Print:
1 jul 2020
Categoría:
Surgery
Resumen:
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 (R-PME) 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.
Filiaciones:
de'Angelis N:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
Notarnicola M:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, 90, Av. de Gaspar Aguilar, 46017, Valencia, Spain
Memeo R:
Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Piazza Umberto I, 1, 70121, Bari, Italy
Charpy C:
Department of Pathology, Henri Mondor Hospital, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Urciuoli I:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Maroso F:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Sommacale D:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Amiot A:
EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
Department of Gastroenterology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Canouï-Poitrine F:
Department of Public Health L, Henri Mondor University Hospital, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
University of Paris Est, Creteil (UPEC), IMRB-U955 INSERM, CEPiA, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Levesque E:
Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
Brunetti F:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
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