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 24 May 2018

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News

Risk of conversion to open laparotomy among patients undergoing resection for rectal cancer

This week's issue of the Journal of the American Medical Association compares robotic-assisted with conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer.

News image

Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy.

Dr David Jayne and colleagues compared robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer.

Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons.

Recruitment of patients was from 2011, to 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on 2015.

Patients were randomized to robotic-assisted or conventional laparoscopic rectal cancer resection, performed by either high or low anterior resection or abdominoperineal resection.

The team's primary outcome was conversion to open laparotomy.

The researcher's secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity and other pathological outcomes, quality of life, bladder and sexual dysfunction, and oncological outcomes.

The team found that among 471 randomized patients, 99% completed the study.

The researchers noted that the overall rate of conversion to open laparotomy was 10%.

The overall rate of conversion to open laparotomy was 10%
Journal of the American Medical Association

The team observed that 8% in the robotic-assisted laparoscopic group, and 12% in the conventional laparoscopic group.

The overall circumferential resection margin positivity rate was 6%, and circumferential resection margin positivity occurred in 6% of patients in the conventional laparoscopic group, and 5% of patients in the robotic-assisted laparoscopic group.

The research team found that of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups.

Dr Jayne's team concludes, "Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy."

"These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection."

JAMA 2017;318(16):1569-1580
26 October 2017

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