Advertisement

Functional outcomes after robotic or laparoscopic intersphincteric resection – An inverse probability weighting analysis

  • Author Footnotes
    1 Mufaddal Kazi and Bhushan Jajoo have contributed equally and are joint first authors.
    Mufaddal Kazi
    Footnotes
    1 Mufaddal Kazi and Bhushan Jajoo have contributed equally and are joint first authors.
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Author Footnotes
    1 Mufaddal Kazi and Bhushan Jajoo have contributed equally and are joint first authors.
    Bhushan Jajoo
    Footnotes
    1 Mufaddal Kazi and Bhushan Jajoo have contributed equally and are joint first authors.
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Jitender Rohila
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Sayali Dohale
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Prajesh Bhuta
    Affiliations
    Division of Colorectal Surgery, Jaslok Hospital and Research Centre, Mumbai, 400026, India
    Search for articles by this author
  • Ashwin Desouza
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Avanish Saklani
    Correspondence
    Corresponding author. Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai, 400012, Maharashtra, India.
    Affiliations
    Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, India

    Homi Bhabha National Institute, Mumbai, 400012, India
    Search for articles by this author
  • Author Footnotes
    1 Mufaddal Kazi and Bhushan Jajoo have contributed equally and are joint first authors.

      Abstract

      Background

      Functional outcomes after robotic and laparoscopic Intersphincteric resections (ISR) have not been studied adequately. We aimed to compare the bowel functions after robotic or laparoscopic ISR.

      Methods

      Single-center, cross-sectional study of minimally invasive ISR. Functional outcomes were assessed on the low anterior resection syndrome (LARS), Wexner incontinence scale, and the Kirwan grading. Baseline characteristics (age, sex, body mass index, T stage, tumour height, preoperative radiation, and anastomotic configuration) in the groups were balanced using inverse probability of treatment weighting (IPTW).

      Results

      Functional outcomes were assessed for 132 patients, 85 laparoscopic and 47 robotic ISR were performed. After IPTW, baseline characteristics were well balanced (mean deviation <0.1). In the weighted cohorts of laparoscopic and robotic ISR, major LARS was observed in 18.1% and 18.5% (p – 0.182) and major incontinence on the Wexner scale in 18.4% and 22.8% (p – 0.443), respectively. The Kirwan grades of incontinence were also similar between the groups (p – 0.794).

      Conclusion

      No differences in bowel functions on the LARS and incontinence scales between laparoscopic and robotic ISR were found in the present study.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jayne D.
        • Pigazzi A.
        • Marshall H.
        • Croft J.
        • Corrigan N.
        • Copeland J.
        • et al.
        Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial.
        JAMA. 2017 Oct 24; 318: 1569-1580
        • Saklani A.P.
        • Lim D.R.
        • Hur H.
        • Min B.S.
        • Baik S.H.
        • Lee K.Y.
        • et al.
        Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes.
        Int J Colorectal Dis. 2013 Dec; 28: 1689-1698
        • Baek S.J.
        • Al-Asari S.
        • Jeong D.H.
        • Hur H.
        • Min B.S.
        • Baik S.H.
        • et al.
        Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer.
        Surg Endosc. 2013 Nov; 27: 4157-4163
        • Kim M.J.
        • Park S.C.
        • Park J.W.
        • Chang H.J.
        • Kim D.Y.
        • Nam B.-H.
        • et al.
        Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial.
        Ann Surg. 2018 Feb; 267: 243-251
        • Bolton W.S.
        • Chapman S.J.
        • Corrigan N.
        • Croft J.
        • Collinson F.
        • Brown J.M.
        • et al.
        The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC/NIHR ROLARR).
        Ann Surg. 2020 Feb 24;
        • Yoo B.-E.
        • Cho J.-S.
        • Shin J.-W.
        • Lee D.-W.
        • Kwak J.-M.
        • Kim J.
        • et al.
        Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes.
        Ann Surg Oncol. 2015 Apr; 22: 1219-1225
        • Pai V.D.
        • Desouza A.
        • De Menezes J.L.
        • Saklani A.P.
        Laparoscopic intersphincteric resection and hand-sewn coloanal anastomosis: a natural orifice specimen extraction technique.
        J Laparoendosc Adv Surg Tech. 2015 May; 25: 396-400
        • Kumar B.R.
        • Pandey D.
        • Bankar S.
        • Rohila J.
        • DeSouza A.
        • Saklani A.
        Robotic total intersphincteric resection with total mesorectal excision in low rectal cancer - a video vignette.
        Colorectal Dis. 2020 Dec; 22: 2344-2345
        • Sakr A.
        • Sauri F.
        • Alessa M.
        • Zakarnah E.
        • Alawfi H.
        • Torky R.
        • et al.
        Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer.
        Chin Med J. 2020 Aug 5; 133: 1824-1833
        • Vaizey C.J.
        • Carapeti E.
        • Cahill J.A.
        • Kamm M.A.
        Prospective comparison of faecal incontinence grading systems.
        Gut. 1999 Jan; 44: 77-80
        • Kirwan W.O.
        • Turnbull R.B.
        • Fazio V.W.
        • Weakley F.L.
        Pullthrough operation with delayed anastomosis for rectal cancer.
        Br J Surg. 1978 Oct; 65: 695-698
        • Chesnaye N.C.
        • Stel V.S.
        • Tripepi G.
        • Dekker F.W.
        • Fu E.L.
        • Zoccali C.
        • et al.
        An introduction to inverse probability of treatment weighting in observational research.
        Clin Kidney J. 2021 Aug 26; 15: 14-20
        • Austin P.C.
        • Stuart E.A.
        Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.
        Stat Med. 2015 Dec 10; 34: 3661-3679
        • Sakr A.
        • Yang S.Y.
        • Kang J.H.
        • Cho M.S.
        • Han Y.D.
        • Min B.S.
        • et al.
        Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: comparative cross sectional study.
        J Surg Oncol. 2020; 121: 365-374
        • Canda A.E.
        • Terzi C.
        • Gorken I.B.
        • Oztop I.
        • Sokmen S.
        • Fuzun M.
        Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients.
        Int J Colorectal Dis. 2010 Feb; 25: 197-204
        • Corrigan N.
        • Marshall H.
        • Croft J.
        • Copeland J.
        • Jayne D.
        • Brown J.
        Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection.
        Trials. 2018 Dec; 19: 339
        • Gori J.
        • Kazi M.
        • Rajkumar B.
        • Bhuta P.
        • Ankathi S.K.
        • Desouza A.
        • et al.
        Comparative study of functional outcomes between ultra-low anterior resection and inter-sphincteric resection: a propensity matched analysis.
        ANZ J Surg. 2022 Jan; 92: 151-156
        • Bregendahl S.
        • Emmertsen K.J.
        • Lous J.
        • Laurberg S.
        Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study.
        Colorectal Dis. 2013 Sep; 15: 1130-1139