Table 1.
Results of studies comparing robotic, laparoscopic, and open approaches to colorectal surgery.
| Study | Ielpo and collegues91 |
Cho and collegues92 |
Park and collegues93 |
Yamaguchi and collegues94 |
Sujatha-Bhaskar and collegues36 |
Kim and collegues106 |
Sammour and collegues72 |
Ghezzi and collegues (2014)107 |
Jayne and collegues (2017)26 |
Xu and collegues (2017)27 |
|---|---|---|---|---|---|---|---|---|---|---|
| Design | Retrospective case series comparison | Retrospective propensity score-matched | Retrospective multicenter propensity score-matched | Prospective case series comparison | Retrospective NCDB review | Retrospective propensity score-matched | Retrospective review of prospective database | Retrospective review of prospective database | International multicenter, randomized, unblinded, parallel group | Multicenter randomized, unblinded, parallel group |
| No. of centers | 1 | 1 | 7 | 1 | 1500 | 1 | 1 | 2 | 29 | 2 |
| Location | Spain | South Korea | South Korea | Japan | United States | Korea | United States | Italy, Brazil | 10 countries | South Korea |
| Period | 2012-2013 | 2007-2011 | 2008-2011 | 2010-2015 | 2010-2014 | 2007-2014 | 2009-2016 | 2004-2010 | 2011-2014 | 2013-2017 |
| Tumor or procedure | ≤15 cm from anal verge | TME | Intersphincteric resection with coloanal anastomosis | Below peritoneal reflection | LARC | ≤15 cm from anal verge | TME | < 10 cm from anal verge | < 15 cm from anal verge | ≤5 cm from anal verge |
| No. of patients | ||||||||||
| Robotic | 56 | 278 | 106 | 203 | 905 | 224 | 276 | 65 | 237 | 173 |
| Laparoscopic | 87 | 278 | 106 | 239 | 2,009 | 224 | 234 | 176 | ||
| Open | 3399 | 109 | 154 | |||||||
| % Patients who Received neoadjuvant treatment | NR | |||||||||
| Robotic | 82 | 32.7 | 64.2 | 0.5 | 100 | 22.3 | 74.6 | 72.3 | 46.8 | |
| Laparoscopic | 81 | 28.4 | 56.6 | 0 | 100 | 22.3 | 46.2 | |||
| Open | 100 | 61.5 | ||||||||
| % Patients with low tumors | P = 0.184 | NR* | NR† | NR‡ | NR | |||||
| Robotic | 32 | 24.8 | 100 | 60.1 | 57.1 | 24.2§ | ||||
| Laparoscopic | 31 | 18.3 | 100 | 52.3 | 60.7 | 26.5§ | ||||
| Open | ||||||||||
| Median BMI | NR | NR∥ | NR | |||||||
| Robotic | 22.8 | 23.5 | 24.3 | 23.4 | 23.3 | 27 | 24.7 | |||
| Laparoscopic | 23.7 | 23.7 | 23.8 | 23.1 | 23.4 | |||||
| Open | 25.4 | |||||||||
| Perioperative outcomes | ||||||||||
| % Patients who underwent conversion | P = 0.04 | P = 0.009 | P = 0.16 | |||||||
| Robotic | 1.8 | 0.7 | 0.9 | 0 | 7 | 0 | 2.2 | 1.5 | 8.1 | 0 |
| Laparoscopic | 9.2 | 0.4 | 1.9 | 3.3 | 14 | 0.9 | 12.2 | 2.4 | ||
| Mean length of stay (days) | P = 0.05 | P > 0.001 | NR | Median; P < 0.001 | Median; P < 0.001 | |||||
| Robotic | 13 | 10.4 | 9.9 | 7.3 | 13.5 | 4 (median) | 6 | 8 | 5.0 | |
| Laparoscopic | 10 | 10.7 | 11.7 | 9.3 | 13.8 | 8.2 | 6.0 | |||
| Open | 9 | 6.0 | ||||||||
| Mean operative time (min) | P = 0.023 | P = 0.001 | NR | P < 0.0001 | P < 0.001 | |||||
| Robotic | 309 | 362 | 272 | 233 | 285.8 | 345 (median) | 299 | 298.5 | 205 | |
| Laparoscopic | 252 | 272 | 233 | 228 | 249.7 | 261.0 | 195 | |||
| Open | 208 | 160 | ||||||||
| % Patients with anastomotic leak | NR | NR | ||||||||
| Robotic | 9.5 | 10.4 | 3.8 | 1.5 | 11.6 | 5.4 | 7.1 | 3 | ||
| Laparoscopic | 4.5 | 10.8 | 5.7 | 2.9 | 11.6 | 2.6 | ||||
| Open | 6.3 | |||||||||
| % Patients who underwent reoperation | NR | NR | NR | NR | NR | NR | NR | |||
| Robotic | 5.3 | 2.9 | 4.6 | |||||||
| Laparoscopic | 3.4 | |||||||||
| Open | 1.8 | |||||||||
| Oncologic outcomes | ||||||||||
| % Patients with CRM ≥ 1 mm | P < 0.05¶ | |||||||||
| Robotic | 96.4 | 95 | 92 | 100 | 95.3 | 96 | 97.5 | 100 | 94.9 | 0.6 |
| Laparoscopic | 97.7 | 95.3 | 91 | 99 | 95.1 | 95.1 | 93.7 | 1.7 | ||
| Open | 92.4 | 98.2 | 1.9 | |||||||
| % Patients with negative DRM | NR | NR | NR | NR | NR | |||||
| Robotic | 100 | 99.6 | 100 | 100 | 100 | |||||
| Laparoscopic | 100 | 98.9 | 100 | 99.6 | ||||||
| Mean lymph node yield | P < 0.05# | P < 0.001 | ||||||||
| Robotic | 10 | 15.0 | 13.2 | 30 | 15.7 | 20.2 | 22 (median) | 20.1 | 23.2 | 16 |
| Laparoscopic | 9 | 16.2 | 15.2 | 29 | 15.2 | 21.0 | 24.1 | 16 | ||
| Open | 14.8 | 14.1 | 15.5 | |||||||
| Distance to DRM (mm) | NR | NR | NR | P = 0.054 | NR | NR | ||||
| Robotic | 20 | 12 | 28 | 23 | 27 | |||||
| Laparoscopic | 22 | 12 | 32 | 24 | ||||||
| Open | 22 | |||||||||
| 5 yr DFS | NR | NR | NR | P = 0.734 | NR | NR | ||||
| Robotic | 91.8 | 80.6 | 72.6 | 82 | 73.2 | |||||
| Laparoscopic | 79.6 | 82.8 | 68 | |||||||
| Open | 69.5 | |||||||||
| 5 yr OS | NR | NR | P = 0.0198** | P = 0.569 | NR | NR | ||||
| Robotic | 92.2 | 88.5 | 78 | 91 | 87 | 85 | ||||
| Laparoscopic | 93.1 | 88.4 | 81 | 78 | ||||||
| Open | 76 | 76.1 | ||||||||
| % Patients with LR within 5 yr | NR | NR | NR | NR | P = 0.024 | NR | NR | |||
| Robotic | 5.9 | 8.7 | 2.4 (3 yr) | 3.4 | ||||||
| Laparoscopic | 3.9 | 8.2 | ||||||||
| Open | 16.1 |
BMI, body-mass index; CRM, circumferential resection margin; DFS, disease-free survival; DRM, distal resection margin; L, laparoscopic; LARC, locally advanced rectal cancer; LR, local recurrence; NCDB, National Cancer Database; NR, not reported; O, open; OS, overall survival; R, robotic; TME, total mesorectal excision.
Abdominoperineal resection: R, 25%; L, 21%; O, 26% (P = 0.037).
In 82.6% of the patients, the tumor was located in the mid or low rectum.
Median distance from anal verge: R, 6.2 cm; O, 6.1 cm.
The percentages are for patients with tumors <5 cm from the anal verge. For patients with tumors located 6-10 cm from the anal verge, the percentages were 45.3% and 43% for robotic and laparoscopic surgery, respectively.
Obese patients (BMI ≥ 30.0): R, 22.8; L, 23.5.
Open vs laparoscopic or robotic.
Robotic vs open.
Robotic and laparoscopic vs open.