Impact of robotic learning curve on histopathology in rectal cancer: A pooled analysis |
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| Institution: | 1. School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, Campus Box 7460, Chapel Hill, NC;2. Physiological Nursing, University of California, San Francisco, 2 Koret Way, N631, San Francisco, CA;3. School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, Campus Box 7460, Chapel Hill, NC;4. Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC;1. Urology Department, “San Carlo di Nancy” Hospital, Rome, Italy;2. University of Brescia, Urology Unit Spedali Civili Hospital, Brescia, Italy;3. University of Brescia, Data Methods and Systems Statistical Laboratory, Brescia, Italy;4. University of Chieti, Urology Unit D''Annunzio Hospital, Chieti, Italy;5. University of Florence, Urology Unit Careggi Hospital, Florence, Italy |
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| Abstract: | BackgroundA beneficial impact of robotic proctectomy on circumferential resection margin (CRM) is expected due to the robot's articulating instruments in the pelvis. There are however concerns about a negative impact on the quality of total mesorectal excision (TME) due to the lack of tactile feedback. The aim of this study was to assess whether surgeons' learning curve impacted CRM and TME quality.MethodsIn a multicenter study, individual patient data of robotic proctectomy for resectable rectal cancer were pooled. Patients were stratified into two phases of surgeons’ learning curve. Cumulative sum (CUSUM) analysis was used to determine the transition from learning phase (LP) to plateau phase (PP), which were compared. CRM was microscopically measured in mm by pathologists. TME quality was classified by pathologists as complete, nearly complete or incomplete. T-test and Chi-squared tests were used to compare continuous and categorical variables, respectively.Results235 patients underwent robotic proctectomy by five surgeons. 83 LP patients were comparable to 152 PP patients for age (p = 0.20), gender (67.5% vs. 65.1% males; p = 0.72), BMI (p = 0.82), cancer stage (p = 0.36), neoadjuvant chemoradiation (p = 0.13), distance of tumor from anal verge (5.8 ± 4.4 vs. 5.5 ± 3.3; p = 0.56). CRM did not differ (7.7 ± 11.4 mm vs. 8.4 ± 10.3 mm; p = 0.62). The rate of complete TME quality was significantly improved in PP patients as compared to LP patients (73.5% vs. 92.1%; p < 0.001).ConclusionWhile learning had no impact on circumferential resection margins, the quality of TME significantly improved during surgeons’ plateau phase as compared to their learning phase. |
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| Keywords: | Robotic surgery Rectal cancer Learning curve Total mesorectal excision Circumferential resection margin |
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