Comparison of clinical effects of Da Vinci robotic and laparoscopic radical resection for obese patients with rectal adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Shihao , TANG Jiyan , SUN Weipeng , YAO Hongyu , DUAN Xiaofei ,  LI Zhen

Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding?author：

LI Zhen, Email: doctorlizhen@126.com

Keywords：

rectal adenocarcinoma; obesity; laparoscope; robotic surgery; autonomic nerve

DOI：

10.7507/1007-9424.202105052

Video：

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Objective To compare and analyze the therapeutic effect of robotic and laparoscopic radical resection of rectal cancer for obese patients with rectal adenocarcinoma. Methods The retrospective cohort study was conducted. The clinicopathologic data of 217 obese patients with rectal adenocarcinoma who were treated in the First Affiliated Hospital of Zhengzhou University from October 2017 to January 2020 were collected, 104 patients received radical resection of rectal cancer assisted by Da Vinci robotic surgical system and were assigned to the robot group, 113 patients underwent laparoscopic-assisted radical resection of rectal cancer and were assigned to the laparoscope group. The perioperative indexes, pathological examination, and postoperative recovery of urogenital function were compared. Results There were no significant differences between the two groups in the gender, age, body mass index, distance from lower edge of tumor to anal edge, tumor diameter, American Association of Anesthesiologists classification, preoperative complications, preoperative carcinoembryonic antigen level, tumor differentiation, and TNM stage (P>0.05). The operations were successfully completed in all patients and there was no conversion to laparotomy and perioperative death. There were no significant differences between the two groups in the operation time, first exhaust time, first eating liquid food time, first getting out of bed activity time, drainage tube placement time, prophylactic stoma rate, and postoperative complications (P>0.05). The intraoperative blood loss and total hospital stay in the robot group were less than those of the laparoscope group (P<0.05). The International Prostate Symptom Score of the robot group was lower than that of the laparoscope group at 3, 6, and 12 months after operation (P<0.05). The International Index of Erectile Function-15 score of male patients and Female Sexual Function Index-19 score of female patients in the robot group were higher than those in the laparoscope group at 3, 6, and 12 months after operation (P<0.05). Conclusions Robotic surgery is safe and effective in treatment of obese patients with rectal adenocarcinoma. Compared with laparoscopic surgery, robotic surgery could benefit patients more in protecting postoperative genitourinary function.

Citation： WANG Shihao, TANG Jiyan, SUN Weipeng, YAO Hongyu, DUAN Xiaofei, LI Zhen. Comparison of clinical effects of Da Vinci robotic and laparoscopic radical resection for obese patients with rectal adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(2): 205-210. doi: 10.7507/1007-9424.202105052 Copy

1.	He Y, Liang D, Li D, et al. Incidence and mortality of laryngeal cancer in China, 2015. Chin J Cancer Res, 2020, 32(1): 10-17.
2.	Silva-Velazco J, Dietz DW, Stocchi L, et al. Considering value in rectal cancer surgery: an analysis of costs and outcomes based on the open, laparoscopic, and robotic approach for proctectomy. Ann Surg, 2017, 265(5): 960-968.
3.	Keller DS, Delaney CP, Hashemi L, et al. A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc, 2016, 30(10): 4220-4228.
4.	Simillis C, Lal N, Thoukididou SN, et al. Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg, 2019, 270(1): 59-68.
5.	Ning Y, Wang L, Giovannucci EL. A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev, 2010, 11(1): 19-30.
6.	Bayraktar O, Ayta? E, ?zben V, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech, 2018, 28(1): e8-e11.
7.	韓彩文, 田宏偉, 杜斌斌, 等. 機器人輔助技術在普外科的應用現狀和前景展望. 中國普外基礎與臨床雜志, 2020, 27(12): 1598-1603.
8.	Son IT, Kim DW, Choe EK, et al. Oncologic evaluation of obesity as a factor in patients with rectal cancer undergoing laparoscopic surgery: a propensity-matched analysis using body mass index. Ann Surg Treat Res, 2019, 96(2): 86-94.
9.	中國醫師協會結直腸腫瘤專業委員會機器人手術專業委員會, 中國研究型醫院學會機器人與腹腔鏡外科專業委員會. 機器人結直腸癌手術中國專家共識(2020版). 中國實用外科雜志, 2021, 41(1): 12-19.
10.	中華醫學會外科學分會腹腔鏡與內鏡外科學組, 中華醫學會外科學分會結直腸外科學組, 中國醫師協會外科醫師分會結直腸外科醫師委員會, 等. 腹腔鏡結直腸癌根治術操作指南(2018版). 中華消化外科雜志, 2018, 17(9): 877-885.
11.	Bunyavejchevin S. Overactive bladder symptom scores responsiveness before and after anticholinergic treatment in women with overactive bladder: the pilot study. J Obstet Gynaecol Res, 2017, 43(7): 1189-1193.
12.	Neijenhuijs KI, Holtmaat K, Aaronson NK, et al. The international index of erectile function (IIEF)—a systematic review of measurement properties. J Sex Med, 2019, 16(7): 1078-1091.
13.	Neijenhuijs KI, Hooghiemstra N, Holtmaat K, et al. The female sexual function index (FSFI)—a systematic review of measurement properties. J Sex Med, 2019, 16(5): 640-660.
14.	NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1 698 population-based measurement studies with 19. 2 million participants. Lancet, 2016, 387(10026): 1377-1396.
15.	Shiomi A, Kinugasa Y, Yamaguchi T, et al. Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis, 2016, 31(10): 1701-1710.
16.	Bjoern MX, Nielsen S, Perdawood SK. Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg, 2019, 23(8): 1623-1630.
17.	Peltrini R, Luglio G, Cassese G, et al. Oncological outcomes and quality of life after rectal cancer surgery. Open Med (Wars), 2019, 14: 653-662.
18.	Eid Y, Bouvier V, Menahem B, et al. Digestive and genitourinary sequelae in rectal cancer survivors and their impact on health-related quality of life: outcome of a high-resolution population-based study. Surgery, 2019, 166(3): 327-335.
19.	Fang J, Zheng Z, Wei H. Reconsideration of the anterior surgical plane of total mesorectal excision for rectal cancer. Dis Colon Rectum, 2019, 62(5): 639-641.
20.	Kim HS, Kang JH, Yang SY, et al. Long-term voiding and sexual function in male patients after robotic total mesorectal excision with autonomic nerve preservation for rectal cancer: a cross-sectional study. Surg Laparosc Endosc Percutan Tech, 2020, 30(2): 137-143.
21.	Aselmann H, Kersebaum JN, Bernsmeier A, et al. Robotic-assisted total mesorectal excision (TME) for rectal cancer results in a significantly higher quality of TME specimen compared to the laparoscopic approach—report of a single-center experience. Int J Colorectal Dis, 2018, 33(11): 1575-1581.
22.	Huang CW, Tsai HL, Yeh YS, et al. Robotic-assisted total mesorectal excision with the single-docking technique for patients with rectal cancer. BMC Surg, 2017, 17(1): 126. doi: 10.1186/s12893-017-0315-x.
23.	Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc, 2006, 20(10): 1521-1525.
24.	唐波, 曾冬竹, 張超, 等. 達芬奇機器人手術系統輔助直腸癌根治術456例報道. 中國普外基礎與臨床雜志, 2016, 23(12): 1419-1423.
25.	Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis, 2018, 33(12): 1741-1753.
26.	Tang X, Wang Z, Wu X, et al. Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis. World J Surg Oncol, 2018, 16(1): 196. doi: 10.1186/s12957-018-1499-y.
27.	Yamaoka Y, Kagawa H, Shiomi A, et al. Robotic-assisted surgery may be a useful approach to protect urinary function in the modern era of diverse surgical approaches for rectal cancer. Surg Endosc, 2021, 35(3): 1317-1323.
28.	Panteleimonitis S, Pickering O, Abbas H, et al. Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis, 2018, 33(8): 1079-1086.
29.	Wang G, Wang Z, Jiang Z, et al. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot, 2017, 13(1): e1725. doi: 10.1002/rcs.1725.

1. He Y, Liang D, Li D, et al. Incidence and mortality of laryngeal cancer in China, 2015. Chin J Cancer Res, 2020, 32(1): 10-17.
2. Silva-Velazco J, Dietz DW, Stocchi L, et al. Considering value in rectal cancer surgery: an analysis of costs and outcomes based on the open, laparoscopic, and robotic approach for proctectomy. Ann Surg, 2017, 265(5): 960-968.
3. Keller DS, Delaney CP, Hashemi L, et al. A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc, 2016, 30(10): 4220-4228.
4. Simillis C, Lal N, Thoukididou SN, et al. Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg, 2019, 270(1): 59-68.
5. Ning Y, Wang L, Giovannucci EL. A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev, 2010, 11(1): 19-30.
6. Bayraktar O, Ayta? E, ?zben V, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech, 2018, 28(1): e8-e11.
7. 韓彩文, 田宏偉, 杜斌斌, 等. 機器人輔助技術在普外科的應用現狀和前景展望. 中國普外基礎與臨床雜志, 2020, 27(12): 1598-1603.
8. Son IT, Kim DW, Choe EK, et al. Oncologic evaluation of obesity as a factor in patients with rectal cancer undergoing laparoscopic surgery: a propensity-matched analysis using body mass index. Ann Surg Treat Res, 2019, 96(2): 86-94.
9. 中國醫師協會結直腸腫瘤專業委員會機器人手術專業委員會, 中國研究型醫院學會機器人與腹腔鏡外科專業委員會. 機器人結直腸癌手術中國專家共識(2020版). 中國實用外科雜志, 2021, 41(1): 12-19.
10. 中華醫學會外科學分會腹腔鏡與內鏡外科學組, 中華醫學會外科學分會結直腸外科學組, 中國醫師協會外科醫師分會結直腸外科醫師委員會, 等. 腹腔鏡結直腸癌根治術操作指南(2018版). 中華消化外科雜志, 2018, 17(9): 877-885.
11. Bunyavejchevin S. Overactive bladder symptom scores responsiveness before and after anticholinergic treatment in women with overactive bladder: the pilot study. J Obstet Gynaecol Res, 2017, 43(7): 1189-1193.
12. Neijenhuijs KI, Holtmaat K, Aaronson NK, et al. The international index of erectile function (IIEF)—a systematic review of measurement properties. J Sex Med, 2019, 16(7): 1078-1091.
13. Neijenhuijs KI, Hooghiemstra N, Holtmaat K, et al. The female sexual function index (FSFI)—a systematic review of measurement properties. J Sex Med, 2019, 16(5): 640-660.
14. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1 698 population-based measurement studies with 19. 2 million participants. Lancet, 2016, 387(10026): 1377-1396.
15. Shiomi A, Kinugasa Y, Yamaguchi T, et al. Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis, 2016, 31(10): 1701-1710.
16. Bjoern MX, Nielsen S, Perdawood SK. Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg, 2019, 23(8): 1623-1630.
17. Peltrini R, Luglio G, Cassese G, et al. Oncological outcomes and quality of life after rectal cancer surgery. Open Med (Wars), 2019, 14: 653-662.
18. Eid Y, Bouvier V, Menahem B, et al. Digestive and genitourinary sequelae in rectal cancer survivors and their impact on health-related quality of life: outcome of a high-resolution population-based study. Surgery, 2019, 166(3): 327-335.
19. Fang J, Zheng Z, Wei H. Reconsideration of the anterior surgical plane of total mesorectal excision for rectal cancer. Dis Colon Rectum, 2019, 62(5): 639-641.
20. Kim HS, Kang JH, Yang SY, et al. Long-term voiding and sexual function in male patients after robotic total mesorectal excision with autonomic nerve preservation for rectal cancer: a cross-sectional study. Surg Laparosc Endosc Percutan Tech, 2020, 30(2): 137-143.
21. Aselmann H, Kersebaum JN, Bernsmeier A, et al. Robotic-assisted total mesorectal excision (TME) for rectal cancer results in a significantly higher quality of TME specimen compared to the laparoscopic approach—report of a single-center experience. Int J Colorectal Dis, 2018, 33(11): 1575-1581.
22. Huang CW, Tsai HL, Yeh YS, et al. Robotic-assisted total mesorectal excision with the single-docking technique for patients with rectal cancer. BMC Surg, 2017, 17(1): 126. doi: 10.1186/s12893-017-0315-x.
23. Pigazzi A, Ellenhorn JD, Ballantyne GH, et al. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc, 2006, 20(10): 1521-1525.
24. 唐波, 曾冬竹, 張超, 等. 達芬奇機器人手術系統輔助直腸癌根治術456例報道. 中國普外基礎與臨床雜志, 2016, 23(12): 1419-1423.
25. Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis, 2018, 33(12): 1741-1753.
26. Tang X, Wang Z, Wu X, et al. Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis. World J Surg Oncol, 2018, 16(1): 196. doi: 10.1186/s12957-018-1499-y.
27. Yamaoka Y, Kagawa H, Shiomi A, et al. Robotic-assisted surgery may be a useful approach to protect urinary function in the modern era of diverse surgical approaches for rectal cancer. Surg Endosc, 2021, 35(3): 1317-1323.
28. Panteleimonitis S, Pickering O, Abbas H, et al. Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study. Int J Colorectal Dis, 2018, 33(8): 1079-1086.
29. Wang G, Wang Z, Jiang Z, et al. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot, 2017, 13(1): e1725. doi: 10.1002/rcs.1725.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of clinical effects of Da Vinci robotic and laparoscopic radical resection for obese patients with rectal adenocarcinoma

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