F. G. Wilder1,2, A. Burnett1, J. Oliver1, R. J. Chokshi1 1Rutgers – New Jersey Medical School,Surgery,Newark, NJ, USA 2Memorial Sloan-Kettering Cancer Center,New York, NY, USA
Introduction: Robotic surgery has been demonstrated to be a viable option for the resection of benign and malignant colorectal diseases. However, data thus far is lacking with regards to long-term oncologic outcomes. We sought to compare the longer term oncologic outcomes of robotic versus laparoscopic resection of colorectal cancer.
Methods: A literature search was performed using the Pubmed, EMBASE, Cochrane, and Medline databases for studies published between 2000 and 2014. Search terms were: colon, rectal, robot, cancer, laparoscopic, oncologic and outcomes. Studies that compared the overall and disease free survival of robotic versus laparoscopic surgery for patients with colon or rectal cancer were included. Meta-analysis was performed using OpenMeta[Analyst] for Windows 8.
Results:There were 5 studies published between 2000-2014 that reported on overall survival (OS), disease free survival (DFS), lymph node (LN) extraction, circumferential resection margin (CRM), short and long-term recurrence. 317 patients across the 5 studies underwent either totally robotic or hybrid (robotic-assisted) resection of colon or rectal cancer. Mean DFS with laparoscopic resection versus robotic resection was 86.2% (±4.4) and 86.9% (±4.0), respectively. Mean OS with laparoscopic resection versus robotic resection was 93.4% (±3.2) and 91.3% (±4.1), respectively. Except for the Park study whose values were at 5 years, all groups reported DFS and OS at 3 years. At 5 years, Park found a DFS of 78.7% (±4.5) for LCS and 81.9% (±3.3) for RCS. OS was 93.5% (±3.2) for LCS and 92.8% (±2.2) for RCS. Robotic surgery was associated with slightly smaller resection margins (0.318cm, p=0.042), resection of fewer nodes (2.173 fewer nodes, p=0.0001), but equivalent odds of a positive CRM (OR 1.08, p=0.859).
Conclusion: Robotic surgery offers comparable overall and disease free survival when compared to laparoscopic surgery for colorectal cancer. However, longer-term follow up and larger patient populations need to be studied before official recommendations can be made.
