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Editorial
 Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Hanorcid
Annals of Coloproctology 2024;40(2):87-88.
DOI: https://doi.org/10.3393/ac.2024.00234.0033
Published online: April 5, 2024

Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Correspondence to: Jeonghee Han, MD, PhD Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Email: Drhjh81@chamc.co.kr
• Received: March 28, 2024   • Accepted: March 30, 2024

© 2024 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the article "A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer" on page 154.
Total mesorectal excision (TME), introduced by Heald et al. [1], is a standard procedure and an essential oncologic surgical principle for mid to low rectal tumors. The concept of TME is to promote preservation of structures, allow en bloc resection of tumor and lymphoid tissue, and provide better functional and oncologic outcomes. However, TME procedures are not always successful due to challenges such as narrow and deep pelvis, advanced tumor, and lack of surgeon's anatomical understanding, which can jeopardize the oncologic outcome. Achieving a complete, high quality TME requires a solid knowledge of the complex pelvic anatomy and well-designed instruments that can work in confined spaces. Therefore, the development of surgical methods that increase the accuracy of TME through innovative devices and techniques is closely related to the outcome of rectal cancer treatment.
Reyes et al. [2] conducted a comparative study of surgical and pathologic outcomes in rectal cancer surgery using open and robotic surgery. The study was the first to compare pathologic outcomes of arterial ligation site, ligated vessel length, and resection margin in specimens from robotic and open surgery. The results showed no significant differences between the 2 surgical methods in distal resection margin and circumferential resection margin, complete mesorectal fascia, vessel length, and total harvested lymph node. Several studies have reported better outcomes with robotic TME than laparoscopic TME in terms of completeness of TME [3]. Furthermore, the recent COLRAR trial [4] showed no significant differences in pathological outcomes, such as completeness of TME, circumferential resection margin, and the number of harvested lymph nodes, between laparoscopic and robotic surgery.
Robotic surgical systems offer several advantages, including advanced stereoscopic 3-dimensional vision, tremor-free movements, and precise rotation and joint movements that enable accurate surgery while preserving nerve and vascular structures in narrow and limited spaces [5]. Furthermore, new and evolving versions of robotic consoles allow for easier multiquadrant access to different anatomical regions or complete robotic surgery through a single docking [6]. Robot-assisted stereotactic real-time navigation surgery is performed using a robotic platform and navigation interface [7]. While this technology is not yet widely available due to several limitations, surgical systems that incorporate navigation will enhance surgeons' perception of the surgical field during complex surgeries in the future.
However, there is still insufficient evidence, including the study by Reyes et al [2], to support the claim that robotic surgery improves oncological outcomes when compared to laparoscopic or open surgery. While the technical advantages of robotic surgery in rectal cancer are increasing, oncological superiority must be established for it to be widely accepted. Therefore, future well-defined randomized studies on the pathological and oncological outcomes of advanced tumors will be essential.

CONFLICT OF INTEREST

Jeonghee Han serves on the Editorial Board of Annals of Coloproctology, but was not involved in the reviewing or decision process of this manuscript. No other potential conflict of interest relevant to this article was reported.

FUNDING

None.

  • 1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1982;69:613–6.ArticlePubMedPDF
  • 2. Reyes R, Kindler C, Smedh K, Tiselius C. A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer. Ann Coloproctol 2024;40:154–60.Article
  • 3. Jang JH, Kim CN. Robotic total mesorectal excision for rectal cancer: current evidences and future perspectives. Ann Coloproctol 2020;36:293–303.ArticlePubMedPMCPDF
  • 4. Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, et al. Comparison of laparoscopic versus robot-assisted surgery for rectal cancers: the COLRAR randomized controlled trial. Ann Surg 2023;278:31–8.ArticlePubMed
  • 5. Stefanidis D, Wang F, Korndorffer JR, Dunne JB, Scott DJ. Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 2010;24:377–82.ArticlePubMedPDF
  • 6. Morelli L, Di Franco G, Guadagni S, Rossi L, Palmeri M, Furbetta N, et al. Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc 2018;32:589–600.ArticlePubMedPDF
  • 7. Atallah S, Parra-Davila E, Melani AG, Romagnolo LG, Larach SW, Marescaux J. Robotic-assisted stereotactic real-time navigation: initial clinical experience and feasibility for rectal cancer surgery. Tech Coloproctol 2019;23:53–63.ArticlePubMedPDF

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        Can robotic surgery lead the way in the treatment of rectal cancer?
        Ann Coloproctol. 2024;40(2):87-88.   Published online April 5, 2024
        DOI: https://doi.org/10.3393/ac.2024.00234.0033
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