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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2021; 75(5): 410–416. doi: 10.48095/ccgh2021410.

Robotic-assisted surgery for colorectal and hepatopancreatobiliary neoplasms

Daniel Langer  1, Michal Vočka  2, Jaroslav Kalvach3, Jaroslav Pažin1, Miroslav Ryska3, Radek Pohnán  3

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Introduction: The Czech Republic belongs to countries under significant strain due to malignant tumours. Despite the changes introduced in the therapy of gastrointestinal malignancies, radical removal of the tumour holds a crucial position in the mutimodal therapeutic process and is irreplaceable nowadays. From the beginning of the third millennium, minimally invasive surgery of abdominal tumours is being expanded with robotic-assisted procedures. The aim of this paper is to assess the benefits of robotic-assisted surgery in the treatment of colorectal and hepatopancreatobiliary neoplasms and to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. Material and method: The authors summarize studies published in the PubMed, EMBASE, Medline and Cochrane Library databases that compare robotic and laparoscopic approaches in the treatment of colorectal and hepatopancreatobiliary malignancies, and present the results of their own non-randomized study. 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 1 January 2016 and 31 December 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analysed. The data were analysed using descriptive statistic methods. Results: 204 patients with rectal cancer of whom 138 were men and 66 were women underwent robotic surgery at our department during the five-year period. In 97 (47.5%) cases the disease was dia­gnosed in an advanced stage (stage III and IV of the TNM classification). 18 patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the dia­gnosis. The liver-first approach was indicated in 8 (44.4%) patients, two patients underwent a radical resection of liver lesions together with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease, partial mesorectal excision was performed in 68 cases. 18 complications were documented. Clinically relevant anastomotic leak requiring intervention occurred in 5 (3.6%) cases. One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Conclusion: Surgical therapy holds a crucial position in the treatment of colorectal and hepatopancreatobiliary neoplasms and represents the only potentially curative procedure in multimodal therapy. Robotic-assisted therapy has become a routine therapeutic modality for colorectal and hepatopancreatobiliary malignancies worldwide. Da Vinci assisted surgeries prevail in the surgical treatment of rectal cancer at the authors’ workplace as well as at some foreign centres. Compared to open and laparoscopic resections of rectal carcinoma, robotic-assisted operations achieve the same clinical and oncological results with a lower rate of complications.


colorectal cancer, pancreatic carcinoma, robotic surgery, jaterní malignity

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1. Weber PA, Merola S, Wasieleweski A et al. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign dinase. Dis Colon Rectum 2002; 45(12): 1689−1696. doi: 10.1007/s10350-004-7261-2.
2. Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 2006; 20(11): 1713–1718. doi: 10.1007/s00 464-005-0771-8.
3. Baik SH, Ko YT, Kang CM et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 2008; 22(7): 1601−1608. doi: 10.1007/s00464-008-9752-z.
4. Baek JH, Pastor C, Pigazzi A. Robotic and laparoscopic total mesorectal exciton for rectal cancer: a case-matched study. Surg Endosc 2011; 25(2): 521−525. doi: 10.1007/s00464-010-1204-x.
5. Kim MJ, Park SCh, Park JW et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 2018; 267(2): 243–251. doi: 10.1097/SLA0000000000002321.
6. Prete FP, Pezzolla A, Prete F et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer. A systematic rereview and meta-analysis of randomized controlled trials. Ann Surg 2018; 267(6): 1034–1046. doi: 10.1097/SLA.0000000000002523.
7. Jayne D, Pigazzi A, Marshall H et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. The ROLARR randomized clinical trial. JAMA 2017; 318(16): 1569–1580. doi: 10.1001/jama.2017.7219.
8. Kim MJ, Park SCh, Park JW et al. Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 2018; 267(2): 243–251. doi: 10.1097/SLA0000000000002321.
9. D’Annibale A, Pernazza G, Monsellato I et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 2013; 27(6): 1887–1895. doi: 10.1007/s00464-012-2731-4.
10. Crippa J, Grass F, Dozois E et al. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort. Ann Surg 2020. doi: 10.1097/SLA.0000000000003805.
11. Kowalewski KF, Seifert L, Ali S et al. Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis. Surg Endosc 2021; 35(1): 81–95. doi: 10.1007/s00464-019-07361-1.
12. Hu JM, Chu ChH, Jiang JK et al. Robotic transanal total mesorectal excision assisted by laparoscopic transabdominal approach: a preliminary twenty-case series report. Asian J Surg 2020; 43(1): 330–338. doi: 10.1016/j.asjsur.2019.06.010.
13. Martinek L, You K, Giuratrabocchetta S et al. Does laparoscopic intracorporeal ileocolic anastomosis decreases surgical site infection rate? A propensity score-matched cohort study. Int J Colorectal Dis 2018; 33(3): 291–298. doi: 10.1007/s00384-017-2957-7.
14. Solaini L, Cavaliere D, Pecchini F et al. Robotic versus laparoscopic right colectomy with intracorporeal anastomosis: a multicenter comparative analysis on short-term outcomes. Surg Endosc 2019; 33(60): 1898–1902. doi: 10.1007/s00464-018-6469-5.
15. Xu H, Li J, Sun Y et al. Robotic versus laparoscopic right colectomy: a meta-analysis. World J Surg Oncol 2014; 12: 27. doi: 10.1186/14 77-7819-12-274.
16. Ma Sa, Chen Y, Chen Y et al. Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: a systematic review and meta-analysis. Asian J Surg 2019; 42(5): 589–598. doi: 10.1016/j.asjsur.2018.11.002.
17. Park JS, Kang H, Park SY et al. Long-term oncologic after robotic versus laparoscopic right colectomy: a prospective randomized study. Surg Endosc 2018; 33(9): 2975–2981. doi: 10.1007/s00464-018-6563-8.
18. Waters PS, Cheung FP, Peacock O et al. Suc­cessful patient-oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review. Colorectal Dis 2020; 22(5): 488–499. doi: 10.1111/codi.14822.
19. Kim JCh, Lee JL, Yoon YS et al. Robotic left colectomy with complete mesocolectomy for splenic flexure and descending colon cancer, compared with a laparoscopic procedure. Int J Med Robot 2018; 14(5): e1918. doi: 10.1002/rcs.1918.
20. Xu M, Zhao Z, Jia B et al. Perioperative and long-term outcomes of robot-assisted versus laparoscopy-assisted hemicolectomy for left-sided colon cancers: a retrospective study. Updates Surg 2021; 73(3): 1049–1056. doi: 10.10007/s13304-020-00959-4.
21. Patriti A, Ceccarelli G, Bartoli A et al. Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg 2009; 16(4): 450−457. doi: 10.1007/s00534-009-0073-y.
22. Berber E, Akyildiz HY, Aucejo F et al. Robotic versus laparoscopic resection of liver tumors. HPB 2010; 12(8): 583−586. doi: 10.1111/j.14 77-2574.2010.00234.x.
23. Giulianotti PC, Coratti A, Sbrana F et al. Robotic liver surgery: results for 70 resections. Surgery 2011; 149(1): 29−39. doi: 10.1016/j.surg.2010.04.002.
24. Choi GH, Choi SH, Kim SH et al. Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc 2012; 26(8): 2247−2258. doi: 10.1007/s00464-012-2168-9.
25. Giulianotti PC, Tzvetanov I et al. Robot-assisted right lobe donor hepatectomy. Transpl Int 2012; 25(1): 5−9. doi: 10.1111/j.1432-22 77.2011.01373.x.
26. Hu Y, Guo K, Xu J et al. Robotic versus laparoscopic hepatectomy for malignancy: a systematic review and meta-analysis. Asian J Surg 2021; 44(4): 615–628. doi: 10.1016/j.asjsur.2020.12.016.
27. Giulianotti PC, Sbrana F, Bianco FM et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 2010; 24(7): 1646−1657. doi: 10.1007/s00464-009-0825-4.
28. Buchs NC, Addeo P, Bianco FM et al. Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 2011; 35(12): 2739−2746. doi: 10.1007/s00268- 011-1276-3.
29. Giulianotti PC, Addeo P, Buchs NC et al. Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors. Pancreas 2011; 40(8): 1264−1270. doi: 10.1097/MPA. 0b013e318220e3a4.
30. Kamarajah SK, Bundred J, Marc OS et al. Robotic versus conventional laparoscopic pan­creaticoduodenectomy a systematic review and meta-analysis. Eur J Surg Oncol 2020; 46(1): 6–14. doi: 10.1016/j.ejso.2019.08.007.
31. Sahni VA, Silveira PC, Sainani NI et al. Impact of a structured report template on the quality of MRI reports for rectal cancer staging. AJR Am J Roentgenol 2015; 205(3): 584–588. doi: 10.2214/AJR.14.14053.
32. Ryska M, Langer D. Chirurgická léčba kolorektálního karcinomu. Onkologie 2013; 7(4): 179–182.
33. Ryska M, Langer D, Kalvach J. Ně­kte­ré současné aspekty chirurgické léčby kolorektálního karcinomu. Onkol Rev 2017; 2: 24–29.
34. Miskovic D, Ahmed J, Bissett-Amess et al. European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis 2019; 21(3): 270–276. doi: 101111/codi.14502.
35. Hoch J, Ferko A, Blaha M et al. Parametrické sledování kvality totální mezorektální excize a chirurgické léčby karcinomu rekta – výsledky multicentrické studie. Rozhl Chir 2016; 95(7): 262–271.
36. Dušek L et al. Czech cancer care in numbers 2008–2009. Praha: Grada Publishing 2009.
37. Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 2006; 20(11): 1713–1718. doi: 10.1007/s00 464-005-0771-8.
38. Langer D, Pudil J, Ryska M. Robotická laparoskopická cholecystektomie. Rozhl Chir 2006; 85(9): 450−454.
39. Belli G. Guest editorial. HPB 2004; 6(4): 195–196. doi: 10.1080/13651820410023 932.
40. Ryska M, Froněk J, Rudiš J et al. Manuální a robotická laparoskopická resekce jater. Dvě kazuistiky. Rozhl Chir 2006; 85(10): 511–516.

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