Comparing open versus robotic surgery in patients with invasive colorectal cancer

This study compared the safety and efficacy of open versus laparoscopic (robotic) surgery in patients with advanced cancer of the colon or rectum (colorectal cancer). 

For patients with CRC, the first treatment option usually is surgery to remove the cancer along with part of the large intestine. In more advanced cases, the cancer can extend to the surrounding organs and tissues in the abdomen. These patients usually need more extensive surgery. Open surgery (OS) involves a large incision in the patient’s abdomen through which the surgeon has access to most of the organs in the abdomen. When parts of more than one organ or structure need to be removed, this is called a multivisceral surgery. However, OS is a rather aggressive procedure and the patients can experience a high risk of complications. Another type of surgery, laparoscopic surgery (LS), also called "keyhole surgery" has proven very good results in terms of survival and complication rates in patients with early-stage CRC. In LS the surgeon makes several small incisions in the abdomen and uses robotic arms that translate the surgeon’s hands for a more precise action, and a video camera to view the content of the abdomen. LS typically results in a reduction in blood loss during surgery and shorter hospital stay. The aim of this study was to compare the safety and efficacy of LS versus OS for a multivisceral resection in patients with advanced CRC.

This study involved 126 Japanese patients diagnosed with CRC that has spread to the surrounding tissues. All patients underwent multivisceral surgery between 2005 and 2012. 60 patients received LS, while the other 66 patients received OS. The authors of the study compared immediate complication rates between the 2 treatment groups.

Results showed that LS lasted longer than OS (271 minutes versus 227 minutes), but the amount of blood loss was significantly reduced in patients who received LS compared to OS (40 ml versus 205 ml). Hospital stay was also significantly shorter for patients in the LS group (13.5 days) compared to patients in the OS group (18 days). Complete removal of the cancer was achieved in 95% of patients in the LS groups and in 98.5% in patients who received OS. Complication rate for patients treated with LS was 28%, compared with 24% for patients in the OS group. 

In summary, laparoscopic multivisceral surgery for advanced CRC can safely replace open surgery in a selected group of patients.

This was a small study. The surgeons conducting the study could have biased the study's results by picking only the least complicated cases for the laparoscopic approach, skewing the results in favor of LS. Also, this study had a very short follow up period which did not permit to evaluate cancer recurrence rate.

Discuss with your doctor which type of surgery is more appropriate in your situation.