Robotic versus laparoscopic surgery in colon and rectal cancer

ABSTRACT

Laparoscopic surgery is an acceptable option for colorectal cancer. Robotic surgery is an emerging methodology and may be a solution to some difficulties inherent to conventional laparoscopic surgery. The aims of this study are to review the outcomes of laparoscopic and robotic surgery, and to discuss robotic surgery from the perspective of treating colorectal cancer. In rectal cancer, robotic surgery takes a longer operative time and has a higher cost, but decreases conversion to open surgery and shortens the learning curve. It has a great potential for preserving bladder and sexual function after total mesorectal excision (TME). The TME quality may also be better. Robotic surgery can also modify the current standard anastomosis following rectal resection, which is a double-stapling technique. Using a robot enables transanal specimen retrieval then a single-circular stapled anastomosis, which is associated with low pain and fast recovery. More solid answers including the long-term oncologic safety will be provided by ongoing randomized trials. In colon cancer, the ease of performing intracorporeal suture anastomosis may be a benefit. Since complete mesocolic excision with wide lymphadenectomy is becoming more and more acceptable to achieve better oncologic outcomes, the role of robotic surgery in providing a stable environment for radically dissecting lymph nodes should be evaluated. Recently developed new technologies such as fluorescent imaging and a robotic stapler seem promising potentially providing further benefits such as a decrease in anastomotic leakage. Single port robotic surgery is also an interesting concept requiring clinical evaluation. Robotic surgery is a developing field and may provide further functional and oncological benefits to colorectal cancer patients. Large scale randomized trials are timely important.