Does robotic rectal cancer surgery offer improved early postoperative outcomes?

Background: Laparoscopic rectal surgery continues to be challenging, especially in low rectal cancers, because the technique has several limitations. Robotic rectal surgery could potentially address these limitations. However, it still remains unclear whether robotic surgery should be accepted as the new standard treatment in rectal cancer surgery.

Objective: The aim of this study is to provide a comprehensive and critical analysis of the available literature to assess if robotic rectal surgery offers improved early postoperative outcomes in comparison with standard laparoscopic rectal surgery.

Data Sources: A systematic review was conducted following the search of electronic databases (PubMed, Science Direct, Google Scholar) for the period 2007 to 2011 by using the key words "rectal surgery," "laparoscopic," "robotic."

Study Selection: All studies reporting outcomes on laparoscopic and robotic resection for extraperitoneal and intraperitoneal rectal cancer were included in the review process; all studies on colonic cancer and benign disease were excluded.

Interventions: A comparison was conducted of robotic vs standard laparoscopic rectal cancer surgery.

Main Outcome Measures: The primary outcome measured was the assessment of whether robotic rectal cancer surgery provides improved short-term outcomes in comparison with standard laparoscopic rectal surgery.

Results: Robotic rectal surgery was associated with increased cost and operating time, but lower conversion rates, even in obese individuals, distal rectal tumors, and patients who had preoperative chemoradiotherapy regardless of the experience of the surgeon. There is also marginally better outcome in anastomotic leak rates, circumferential resection margin positivity, and perseveration of autonomic function, but this did not reach statistical significance.

Limitations: This review has some limitations because it relies on the analysis of data collected from various nonrandomized controlled trials with variable quality and different methodology.

Conclusion: The current evidence suggests that robotic rectal surgery could potentially offer better short-term outcomes especially when applied in selected patients. Obesity, male sex, preoperative radiotherapy, and tumors in the lower two-thirds of the rectum may represent selection criteria for robotic surgery to justify its increased cost.