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Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching.
Dis Colon Rectum. 2017 Mar; 60(3):266-273.DC

Abstract

BACKGROUND

Robotic total mesorectal excision for rectal cancer has rapidly increased and has shown short-term outcomes comparable to conventional laparoscopic total mesorectal excision. However, data for long-term oncologic outcomes are limited.

OBJECTIVE

The aim of this study is to evaluate long-term oncologic outcomes of robotic total mesorectal excision compared with laparoscopic total mesorectal excision.

DESIGN

This was a retrospective study.

SETTINGS

This study was conducted in a tertiary referral hospital.

PATIENTS

A total of 732 patients who underwent totally robotic (n = 272) and laparoscopic (n = 460) total mesorectal excision for rectal cancer were included in this study.

MAIN OUTCOME MEASURES

We compared clinicopathologic outcomes of patients. In addition, short- and long-term outcomes and prognostic factors for survival were evaluated in the matched robotic and laparoscopic total mesorectal excision groups (224 matched pairs by propensity score).

RESULTS

Before case matching, patients in the robotic group were younger, more likely to have undergone preoperative chemoradiation, and had a lower tumor location than those in the laparoscopic group. After case matching most clinicopathologic outcomes were similar between the groups, but operative time was longer and postoperative ileus was more frequent in the robotic group. In the matched patients excluding stage IV, the overall survival, cancer-specific survival, and disease-free survival were better in the robotic group, but did not reach statistical significance. The 5-year survival rates for robotic and laparoscopic total mesorectal excision were 90.5% and 78.0% for overall survival, 90.5% and 79.5% for cancer-specific survival, and 72.6% and 68.0% for disease-free survival. In multivariate analysis, robotic surgery was a significant prognostic factor for overall survival and cancer-specific survival (p = 0.0040, HR = 0.333; p = 0.0161, HR = 0.367).

LIMITATIONS

This study has the potential for selection bias and limited generalizability.

CONCLUSIONS

Robotic total mesorectal excision for rectal cancer showed long-term survival comparable to laparoscopic total mesorectal excision in this study. Robotic surgery was a good prognostic factor for overall survival and cancer-specific survival, suggesting potential oncologic benefits.

Authors+Show Affiliations

1Department of Surgery, Korea University College of Medicine, Seoul, Korea 2Department of Statistics, Korea University College of Political Science and Economics, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28177988

Citation

Kim, Jin, et al. "Robotic Resection Is a Good Prognostic Factor in Rectal Cancer Compared With Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching." Diseases of the Colon and Rectum, vol. 60, no. 3, 2017, pp. 266-273.
Kim J, Baek SJ, Kang DW, et al. Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching. Dis Colon Rectum. 2017;60(3):266-273.
Kim, J., Baek, S. J., Kang, D. W., Roh, Y. E., Lee, J. W., Kwak, H. D., Kwak, J. M., & Kim, S. H. (2017). Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching. Diseases of the Colon and Rectum, 60(3), 266-273. https://doi.org/10.1097/DCR.0000000000000770
Kim J, et al. Robotic Resection Is a Good Prognostic Factor in Rectal Cancer Compared With Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching. Dis Colon Rectum. 2017;60(3):266-273. PubMed PMID: 28177988.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching. AU - Kim,Jin, AU - Baek,Se-Jin, AU - Kang,Dong-Woo, AU - Roh,Young-Eun, AU - Lee,Jae Won, AU - Kwak,Han-Deok, AU - Kwak,Jung Myun, AU - Kim,Seon-Hahn, PY - 2017/2/9/entrez PY - 2017/2/9/pubmed PY - 2017/2/18/medline SP - 266 EP - 273 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 60 IS - 3 N2 - BACKGROUND: Robotic total mesorectal excision for rectal cancer has rapidly increased and has shown short-term outcomes comparable to conventional laparoscopic total mesorectal excision. However, data for long-term oncologic outcomes are limited. OBJECTIVE: The aim of this study is to evaluate long-term oncologic outcomes of robotic total mesorectal excision compared with laparoscopic total mesorectal excision. DESIGN: This was a retrospective study. SETTINGS: This study was conducted in a tertiary referral hospital. PATIENTS: A total of 732 patients who underwent totally robotic (n = 272) and laparoscopic (n = 460) total mesorectal excision for rectal cancer were included in this study. MAIN OUTCOME MEASURES: We compared clinicopathologic outcomes of patients. In addition, short- and long-term outcomes and prognostic factors for survival were evaluated in the matched robotic and laparoscopic total mesorectal excision groups (224 matched pairs by propensity score). RESULTS: Before case matching, patients in the robotic group were younger, more likely to have undergone preoperative chemoradiation, and had a lower tumor location than those in the laparoscopic group. After case matching most clinicopathologic outcomes were similar between the groups, but operative time was longer and postoperative ileus was more frequent in the robotic group. In the matched patients excluding stage IV, the overall survival, cancer-specific survival, and disease-free survival were better in the robotic group, but did not reach statistical significance. The 5-year survival rates for robotic and laparoscopic total mesorectal excision were 90.5% and 78.0% for overall survival, 90.5% and 79.5% for cancer-specific survival, and 72.6% and 68.0% for disease-free survival. In multivariate analysis, robotic surgery was a significant prognostic factor for overall survival and cancer-specific survival (p = 0.0040, HR = 0.333; p = 0.0161, HR = 0.367). LIMITATIONS: This study has the potential for selection bias and limited generalizability. CONCLUSIONS: Robotic total mesorectal excision for rectal cancer showed long-term survival comparable to laparoscopic total mesorectal excision in this study. Robotic surgery was a good prognostic factor for overall survival and cancer-specific survival, suggesting potential oncologic benefits. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/28177988/Robotic_Resection_is_a_Good_Prognostic_Factor_in_Rectal_Cancer_Compared_with_Laparoscopic_Resection:_Long_term_Survival_Analysis_Using_Propensity_Score_Matching_ L2 - http://dx.doi.org/10.1097/DCR.0000000000000770 DB - PRIME DP - Unbound Medicine ER -