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Patient quality of life and short-term surgical outcomes between robotic and laparoscopic anterior resection for adenocarcinoma of the rectum

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Abstract

Purpose

To compare patient quality of life (QoL) and short-term surgical outcomes between robotic anterior resection (r-AR) and laparoscopic (l-AR) approach.

Methods

Consecutive patients having undergone either robotic or laparoscopic AR for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by post-operative histology and short-term complications. QoL was prospectively assessed using the EORTC QLC-CR30 and QLC-CR29 questionnaires.

Results

In total, 36 patients (18 r-AR) with a median follow-up of 12 months following surgery (9-month robotic and 20-month laparoscopic) were studied. The two groups were similarly matched for age and gender. Laparoscopic patients had a lower ASA grade (p = 0.02). There was no significant difference in surgical outcomes between groups. r-AR patients reported lower pain scales (2 ± 6 vs. 11 ± 13) (p = 0.04), lower levels of insomnia 0 vs. 8 ± 15 (p = 0.04) and a lower abdominal pain scale (2 ± 9 vs. 17 ± 27) (p = 0.04). Male impotence scores were higher in l-AR 33 ± 35 compared to r-AR 7 ± 21 (p = 0.03).

Conclusion

Despite its recent introduction to our centre, the quality of oncological resection using the robotic surgery is comparable to laparoscopy. Lower impotence and QoL scores in patients after robotic procedure may be explained on the basis of better visualisation and precise tissue handling.

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References

  1. Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484

    Article  PubMed  Google Scholar 

  2. Freshman J, Branda M, Sargent D et al (2015) Effect of laparoscopic-assisted resection vs. open resection of stage II or II Rectal cancer on pathologic outcomes: the acosog Z6051 Randomised Clinical Trial. JAMA 314(13):1346–1355

    Article  CAS  Google Scholar 

  3. Stevenson ARL, for the ALaCaRT Investigators et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363

    Article  PubMed  CAS  Google Scholar 

  4. Bartels SA, Vlug MS, Ubbink DT, Bemelman WA (2010) Quality of life after laparoscopic and open colorectal surgery: a systematic review. World J Gastroenterol 16(40):5035–5041

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ng KH, Lim YK, Ho KS, Ooi BS, Eu KW (2009) Robotic-assisted surgery for low rectal dissection: from better views to better outcome. Singapore Med J 50(8):763–767

    PubMed  CAS  Google Scholar 

  6. Wibe A et al (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47(1):48–58

    Article  PubMed  Google Scholar 

  7. Moszkowicz D et al (2011) Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis 13(12):1326–1334

    Article  PubMed  CAS  Google Scholar 

  8. Hassan I, Cima RR (2007) Quality of life after rectal resection and multimodality therapy. J Surg Oncol 96(8):684–692

    Article  PubMed  Google Scholar 

  9. Baek SJ, Al-Asari S, Jeong DH, Hur H, Min BS, Baik SH et al (2013) Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc 27:4157–4163

    Article  PubMed  Google Scholar 

  10. Bianchi PP, Ceriani C, Locatelli A, Spinoglio G, Zampino MG, Sonzogni A et al (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24(11):2888–2894

    Article  PubMed  CAS  Google Scholar 

  11. Fernandez R, Anaya DA, Li LT, Orcutt ST, Balentine CJ, Awad SA et al (2013) Laparoscopic versus robotic rectal resection for rectal cancer in a veteran population. Am J Surg 206(4):509–517

    Article  PubMed  Google Scholar 

  12. Aaronson NK et al (1993) The European Organisation for Research and Treatment of Cancer QLQC30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    Article  PubMed  CAS  Google Scholar 

  13. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomlyet A, on behalf of the EORTC Quality of Life Group (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels

    Google Scholar 

  14. Heald RJ et al (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  PubMed  CAS  Google Scholar 

  15. Pigazzi A, Luca F, Patriti A et al (2010) Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 17(6):1614–1620

    Article  PubMed  Google Scholar 

  16. Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH et al (2009) The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 23(2):438–443

    Article  PubMed  Google Scholar 

  17. Arndt V, Merx H, Stegmaier C et al (2004) Quality of life in patients with colorectal cancer 1 year after diagnosis compared with the general population: a population-based study. J Clin Oncol 22:4829–4836

    Article  PubMed  Google Scholar 

  18. Kinoshita et al (2015) A longitudinal study of gender differences in quality of life among Japanese patients with lower rectal cancer treated with sphincter-saving surgery: a 1-year follow-up. World J Surg Oncol 13:91

    Article  PubMed  PubMed Central  Google Scholar 

  19. Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238(2):203–213

    PubMed  PubMed Central  Google Scholar 

  20. Ramsey SD, Andersen MR, Etzioni R et al (2000) Quality of life in survivors of colorectal carcinoma. Cancer 88(6):1294–1303

    Article  PubMed  CAS  Google Scholar 

  21. Shams M, Atef H (2010) Evaluation of the surgical factor in postoperative pain control. Saudi J Anaesth 4(3):127–130

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mossman J, Boudioni M, Slevin ML (1999) Cancer information: a cost-effective intervention. Eur J Cancer 35:1587–1591

    Article  PubMed  CAS  Google Scholar 

  23. Hartford et al (2013) Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: effects of anxiety. Heart Lung 31(3):199–206

    Article  Google Scholar 

  24. Havenga K et al (2000) Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol 18(3):235–243

    Article  PubMed  CAS  Google Scholar 

  25. Nishizawa Y, Ito M, Saito N et al (2011) Male sexual dysfunction after rectal cancer surgery. Int J Colorectal Dis 26(12):1541–1548

    Article  PubMed  Google Scholar 

  26. Asoglu O et al (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23:296–302

    Article  PubMed  Google Scholar 

  27. Jayne DG, Brown JM, Thorpe H, Walker J, Guillou P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92(9):1124–1132

    Article  PubMed  CAS  Google Scholar 

  28. Broholm M, Pommergaard HC, Gögenür I (2015) Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction: a systematic review and meta-analysis. Colorectal Dis 17(5):375–381

    Article  PubMed  CAS  Google Scholar 

  29. Nelson H et al (2001) Guidelines 2000 for Colon and Rectal Cancer Surgery. Natl Cancer Inst 93(8):583–596

    Article  CAS  Google Scholar 

  30. Cho MS, Min BS (2014) Robotic versus laparoscopic single port anterior resection for sigmoid colon cancer. Surg Endosc Other Interv Tech 28(323):0930–2794

    Google Scholar 

  31. Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N (2011) Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 9:2972–2979

    Article  Google Scholar 

  32. Nasir M et al (2016) Learning curves in robotic rectal cancer surgery: a literature review. J Minim Invasive Surg Sci 5(4):e41196. doi:10.17795/minsurgery-41196

    Article  Google Scholar 

  33. Kim et al (2014) Is prior laparoscopy experience required for adaptation to robotic rectal surgery?: feasibility of one-step transition from open to robotic surgery. Int J Colorectal Dis 29(6):693–699

    Article  PubMed  Google Scholar 

  34. Fucini C, Gattai R, Urena C et al (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15(4):1099–1106

    Article  PubMed  CAS  Google Scholar 

  35. De Campos-Lobato LF, Alves-Ferreira PC, Lavery IC, Kiran RP (2011) Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer. Clinics. 66(6):1035–1040

    Article  PubMed  PubMed Central  Google Scholar 

  36. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B (2005) Prospective evaluation of quality of life of patients receiving either abdominoperineal resection or sphincter-pre- serving procedure for rectal cancer. Ann Surg Oncol 12(2):117–123

    Article  PubMed  Google Scholar 

  37. RObotic Versus LAparoscopic Resection for Rectal Cancer An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus laparoscopic surgery for treatment of rectal cancer. ClinicalTrials.gov Identifier: NCT01736072

  38. Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C et al (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nerve- sparing total mesorectal excision for rectal cancer. Ann Surg 257(4):672–678. doi:10.1097/SLA.0b013e318269d03b

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Mr Tony Roberts for his help with statistical analysis and Dr Ross Fowkes who contributed to data collection.

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Authors and Affiliations

  1. South Tees NHS Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK

    D. Kamali, K. Omar, S. Z. Imam, A. Jha, A. Reddy & M. Jha

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  1. D. Kamali
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  2. K. Omar
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  3. S. Z. Imam
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  4. A. Jha
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  5. A. Reddy
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  6. M. Jha
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Correspondence to D. Kamali.

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The authors declare that they have no conflict of interest.

Ethical approval

Following completion of an online decision tool developed by the Medical Research Council Regulatory Support Centre, it was determined that this study did not require research ethic committee approval.

Informed consent

Informed consent was obtained from all participants who undertook the questionnaire.

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Kamali, D., Omar, K., Imam, S.Z. et al. Patient quality of life and short-term surgical outcomes between robotic and laparoscopic anterior resection for adenocarcinoma of the rectum. Tech Coloproctol 21, 355–361 (2017). https://doi.org/10.1007/s10151-017-1631-y

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  • DOI: https://doi.org/10.1007/s10151-017-1631-y

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