D.V. Gladyshev1,3, M.E.Moiseev1, D.S. Shelegetov3, S.A. Kovalenko1, S.S. Gnedash1, A.M. Karachun2
1City hospital №40, Saint-Petersburg, Sestroretsk
2Petrov National Medical Research Cancer Center, Saint-Petersburg, Pesochnyy
3Kirov Military Medical Academy, Saint-Petersburg
Gladyshev D.V. ― Cand. Med. Sc., Deputy chief doctor of surgery, surgeon of the City hospital №40, colonel medical service reserves of the Kirov Military Medical Academy
9 Borisov Str., Saint-Petersburg, Sestroretsk, 197706, tel. +7-911-144-91-21, e-mail: email@example.com
Abstract. Robotic systems are getting widely spread given the different advantages over traditional laparoscopy. Aim of this study to analyze surgical, clinical and oncological outcomes using the da Vinci surgical system.
The prospective collected data on treatment of 238 patients with rectal cancer from 2010 to 2016 were included in the study: 24 patients underwent traditional open surgery, 101 patients underwent laparoscopic surgery and 113 with robotic rectum resection.
Sphincter preserving operations were significantly often performed in the minimally invasive group than open surgery (p<0.0001), and significantly often in robotic group than laparoscopic. The best lenth of stay was achieved in the robotic group ― the median of the hospital stay was 7 days. It was significantly less in comparison with the open surgery group (p<0.0001), and laparoscopic group (p<0.0001). An earlier return of bowel motility was significantly faster in the groups of minimally invasive surgery. The R0 resection did not differ in the groups of laparoscopic and robotic surgery (p=0,738). There were no differences compared to the open surgery group (p=0,999). The quality of mesorectal excision was assessed more often as high and satisfactory in robotic group compared with laparoscopic ones, but the difference between the groups studied in this indicator was statistically insignificant ― OR=2.85 (95% CI: 0.72-11.27; p=0.2). The trend toward a lower incidence of relapse in the robotic surgery group was not significant compared to the laparoscopic (p=0.23) surgery group. The trend towards a lower incidence of metastasis in the open surgery group was not significant with respect to the laparoscopic group (p=0.458) nor to the robotic group (p=1). Differences between groups of minimally invasive surgery were also not significant (p=0.165). Differences between the groups of open and minimally invasive surgery for survival were not reliable: between the open and laparoscopic surgery groups p=0.944, open and robotic p=0.209. Overall survival in the group of laparoscopic surgery was significantly higher than in the robotic p=0.043.
Based on our experience, we can only talk about the tendency to improve the quality of surgical interventions and reduce the number of complications. Clarification of the statistical characteristics of the factors affecting the outcome will be possible with the accumulation of more clinical experience in a multicenter study.
Key words: rectal cancer, robotic mesorectal excision, robotic surgery.