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, Aytaç E, Özben 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.	韩彩文, 田宏伟, 杜斌斌, 等. 机器人辅助技术在普外科的应用现状和前景展望. 中国普外基础与临床杂志, 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.	中国医师协会结直肠肿瘤专业委员会机器人手术专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人结直肠癌手术中国专家共识(2020版). 中国实用外科杂志, 2021, 41(1): 12-19.
10.	中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科医师委员会, 等. 腹腔镜结直肠癌根治术操作指南(2018版). 中华消化外科杂志, 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, 张超, 等. 达芬奇机器人手术系统辅助直肠癌根治术456例报道. 中国普外基础与临床杂志, 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, Aytaç E, Özben 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. 韩彩文, 田宏伟, 杜斌斌, 等. 机器人辅助技术在普外科的应用现状和前景展望. 中国普外基础与临床杂志, 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. 中国医师协会结直肠肿瘤专业委员会机器人手术专业委员会, 中国研究型医院学会机器人与腹腔镜外科专业委员会. 机器人结直肠癌手术中国专家共识(2020版). 中国实用外科杂志, 2021, 41(1): 12-19.
10. 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科医师委员会, 等. 腹腔镜结直肠癌根治术操作指南(2018版). 中华消化外科杂志, 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, 张超, 等. 达芬奇机器人手术系统辅助直肠癌根治术456例报道. 中国普外基础与临床杂志, 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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