Robotic Total Mesorectal Excision Brings Better Short-term Functions Recovery Compared with Laparoscopic Surgeries

 

Authors:

Chengshuai Si， Yuepeng Cao, Liu Yang.

 

Department of Colorectal Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University

 

Instruction:Laparoscopic and robotic surgeries are widely used for rectal cancer. However, the short-term outcomes of robotic and laparoscopic surgeries，especially intestinal, urinary, and sexual functions have not been demonstrated for low rectal cancer.

Methods and procedures:

Between January 2021 and July 2024, 96 patients with cT2-3N0-2M0 low rectal cancer in Jiangsu Cancer Hospital treated with robotic Total Mesorectal Excision (TME) by one surgeon were included in our study. Patients treated with Laparoscopic TME were matched at 1:1 ratio with tumor location, sex, clinical stage. All patients were conducted with TME with temporary ileostomy，with high ligation at the root of the inferior mesenteric artery (IMA). Blood examinations were taken before and 1 day after surgery. Urinary symptoms and sexual function were assessed using the EORTC QLQ-CR29 questionnaire 3 months after surgery. Perioperative clinicopathologic outcomes, Postoperative urinary function, male sexual function recovery, and bowel function of patients in the laparoscopic and robotic surgery groups collected and analyzed. Analysis of variance between groups was employed for categorical variables, whereas an independent sample t-test was used for continuous variables. SPSS 25 was used for statistical analysis and p < 0.05 was considered statistically significant.

Results:

A total of 192 patients were included in the study（table 1）. As shown in Table 2, the inflammatory factors (neutrophils, lymphocytes, NLR, and albumin) were similar between the two groups preoperatively. However, postoperative neutrophils and change of neutrophils were significantly higher in the laparoscopic TME group compared with those in the robotic TME group (table 2). Compared with laparoscopic total mesorectal excision (TME), robotic TME brings obviously quicker recovery of bowel function, first flatus at 26.31 hours after surgery. After surgery, the scores of sexual and urinary function in the laparoscopic and robotic groups were significantly changed. The sexual and urinary function of patients in the robotic group gradually approached normal at 6 months after surgery, whereas those of the laparoscopic group approached normal at 12 months post-surgery (figure1 and 2). After ileostomy restoration, The bowel function of robotic group was significant superior to the control at that time. However, the defecation function of both groups was significantly lower than that before surgery (figure 3).

Conclusions:

Compared with laparoscopic TME, robotic TME has less inflammatory response, and quicker postoperative recovery of intestinal, urinary, and sexual functions.