Keyhole or robotic surgery following chemo-radiation?

This study compared the outcomes of patients treated with laparoscopic (keyhole) or robotic surgery for mid-low rectal cancer after long-term chemo-radiotherapy treatment.

A long course of chemo-radiotherapy (a combination between cytotoxic drugs and radiotherapy) before surgery for the treatment of colorectal cancer can result in 15-20% of patients having no further signs of the cancer (complete response). Although in some cases the tumor is not fully destroyed by chemotherapy, this treatment usually helps by shrinking the tumor or killing cancer cells that have migrated away from the original place (partial response), thus making easier for a surgeon to remove the tumor. However, operating on patients who have not achieved a complete response after long term chemo-radiotherapy can be difficult. Studies have shown that laparoscopic (keyhole) surgery (the surgeon makes small incisions in the abdomen and uses a camera to see inside the patient’s body and remove the tumor) causes side effects such as urinary and sexual dysfunction. Another newer surgical technique is robotic, computer-assisted surgery (the surgeon uses a computer to control very small surgical instruments attached to a robotic arm). This technique has previously been shown to result in fewer complications and side effects. However few studies have compared the outcomes after the two surgical procedure of patients who have previously received chemo-radiotherapy for rectal cancer.

Between January 2006 and December 2010, 138 patients were included in this study. All patients had mid-low rectal cancer (the cancer is less than 12 cm from the opening of the anus on the surface of the body or anal verge). All participants had received chemo-radiotherapy and then were treated with either laparoscopic (64 patients) or robotic surgery (74 patients).

Results showed that 4 patients (6.3%) in the laparoscopic group required conversion to open surgery (the surgeon makes one large incision in the abdomen to reach and cut out the tumor) compared to 1 patient (1.4%) in the robotic surgery group. Three years after surgery, 4 patients (6.3%) in the laparoscopic treatment group had a recurrence (return of the cancer) compared to 2 patients (2.7%) in the robotic treatment group. Overall survival (the percentage of patients who survived a certain time after treatment) 3 years after surgery was 92.1% in patients treated with laparoscopic surgery compared to 90% in patients treated with robotic surgery. Also, disease-free survival (the percentage of patients who survived without the cancer returning a certain time after treatment) 3 years after treatment was 78.8% in the laparoscopic group compared to 77.7% in the robotic surgery group. 

In summary, laparoscopic and robotic surgery for the removal of mid-low rectal cancer resulted in similar outcomes. However, in robotic surgery there is a slight trend towards fewer recurrences and fewer conversions into open surgery.

Talk to your doctor about the most appropriate treatment for your situation.