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Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy

 Dae Ro Lim  ;  Sung Uk Bae  ;  Hyuk Hur  ;  Byung Soh Min  ;  Seung Hyuk Baik  ;  Kang Young Lee  ;  Nam Kyu Kim 
 Surgical Endoscopy , Vol.31(4) : 1728-1737, 2017 
Journal Title
 Surgical Endoscopy  
Issue Date
Adenocarcinoma/mortality ; Adenocarcinoma/surgery* ; Adenocarcinoma/therapy ; Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Male ; Middle Aged ; Neoadjuvant Therapy ; Rectal Neoplasms/mortality ; Rectal Neoplasms/surgery* ; Rectal Neoplasms/therapy ; Rectum/surgery* ; Retrospective Studies ; Robotic Surgical Procedures* ; Survival Analysis
Laparoscopic surgery ; Oncological outcomes ; Rectal cancer ; Robotic surgery
PROPOSE: The use of robotic surgery and neoadjuvant chemoradiation therapy (CRT) for rectal cancer is increasing steadily worldwide. However, there are insufficient data on long-term outcomes of robotic surgery in this clinical setting. The aim of this study was to compare the 5-year oncological outcomes of laparoscopic vs. robotic total mesorectal excision for mid-low rectal cancer after neoadjuvant CRT. MATERIALS AND METHODS: One hundred thirty-eight patients who underwent robotic (n = 74) or laparoscopic (n = 64) resections between January 2006 and December 2010 for mid and low rectal cancer after neoadjuvant CRT were identified from a prospective database. The long-term oncological outcomes of these patients were analyzed using prospective follow-up data. RESULTS: The median follow-up period was 56.1 ± 16.6 months (range 11-101). The 5-year overall survival (OS) rate of the laparoscopic and robotic groups was 93.3 and 90.0 %, respectively, (p = 0424). The 5-year disease-free survival (DFS) rate was 76.0 % (laparoscopic) vs. 76.8 % (robotic) (p = 0.834). In a subgroup analysis according to the yp-stage (complete pathologic response, yp-stage I, yp-stage II, or yp-stage III), the between-group oncological outcomes were not significantly different. The local recurrence rate was 6.3 % (laparoscopic, n = 4) vs. 2.7 % (robotic, n = 2) (p = 0.308). The systemic recurrence rate was 15.6 % (laparoscopic, n = 10) vs. 18.9 % (robotic, n = 14) (p = 0.644). All recurrences occurred within less than 36 months in both groups. The median period of recurrence was 14.2 months. CONCLUSION: Robotic surgery for rectal cancer after neoadjuvant CRT can be performed safely, with long-term oncological outcomes comparable to those obtained with laparoscopic surgery. More large-scale studies and long-term follow-up data are needed.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Bae, Sung Uk(배성욱)
Baik, Seung Hyuk(백승혁) ORCID logo https://orcid.org/0000-0003-4183-2332
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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