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Introduction
Laparoscopic colectomy is the standard of care for primary colorectal cancer (CRC) resections. The benefits of robotic techniques have been described throughout the gynecologic and urologic literature, but the data relating to colorectal cancer resections is still in its infancy. A review of the literature and analysis of outcomes will help us to determine the safety and oncologic value of this technology in CRC.
Methods:
A Pubmed literature search was performed using key search words "robotics", "colorectal", "cancer", and "laparoscopic". After exclusions, 13 studies were identified from 2000-2012. 6 studies were a direct comparison between robotics and laparoscopic surgery for CRC and the remaining 7 looked only at robotic surgery for CRC. The series of resections were analyzed for demographics, type of procedure, procedure length (PL), length of stay (LOS), estimated blood loss (EBL), complications, and oncologic outcomes (Table 1). Non-parametric statistical analyses were performed with GraphPad software (La Jolla, CA).
Results:
Thirteen studies were identified that directly compared the outcomes of laparoscopic and robotic surgery for CRC. When hybrid resections were detailed, laparoscopic methods were used only for establishing pneumoperitoneum or early dissection. There were no statistically significant differences between the groups in age, gender distribution, procedure length, EBL when reported, or LOS (Table 2).
Complications were reported in 10 out of the 13 papers and were graded according to the Clavien-Dindo Scale. 100% of the groups had some type of complication. Of the top 3 complications reported in the robotics group, 20% were Grade I, 90% were Grade II and 80% were Grade III. In the 4 of 6 laparoscopic groups reporting, 75% of 3 most common complications were Grade I, 50% Grade II, and 100% Grade III. The most common complications in both laparoscopic and robotic groups were ileus, anastomotic leak and wound infection. Number of conversions at 3 approached significance in the laparoscopic group (p=0.06). 2 of the 13 papers looked at oncologic outcomes based on recurrence at follow-up. At 17 months follow-up, the recurrence rate was 5.4% in the robotics cases and 5.5% in the laparoscopic group. 1 report looked specifically at long-term survival outcomes with a reported disease-free survival of 77.9% at 3 years and overall survival of 97% at 3 years in the robotics groups.
Conclusions:
Robotic colectomy for CRC is still in its infancy. However, early data indicates that it is a safe and feasible option in comparison to laparoscopic techniques. Outcomes may be comparable, but there is need for longer term follow-up and prospective data.
Table 2. Robotic vs Laparoscopic Outcomes

	Robotic	Laparoscopic	p
Median age (years)	60.3 (56-69)	63.5 (59-70)	0.09
Number of Males	25 (3-87)	30 (2-74)	0.70
EBL (ml)	175 (104-283)	225 (150-300)	0.61
Nodes (number)	17.8 (7-22.03)	17.9 (16.2-22.85)	0.27
LOS (days)	6.5 (4-9.2)	6.6 (3.6-8.31)	0.78
Conversions	0 (0-7)	3 (0-9)	0.06
PL (Minutes)	285 (190-384)	247.5 (191-315)	0.27

EBL - Estimated Blood Loss; LOS - Length of Stay; PL - Procedure Length

Table 1. Demographics, Surgical and Pathological Data

Author/Study	Robotic (R) or Laparoscopic (L)	Age**	Male:Female	EBL (cc)	LOS (days)	Nodes (number)	PL (minutes)	Conversions	Resection	Path (staging)
deSouza	R (Hybrid*)	63	28:16	150	5	14	347	2	LAR - 30 APR - 8 IS - 6	Rectal CA, stages unspecified
Baik (2008)	R	56	8:1	---	7.4	20.1	221	0	TME	I - 3 II - 6 Rectal CA
Hellan	R (Hybrid)	58	21:18	200	4	13	285	1	LAR - 22 CA- 11 APR - 6	0 - 8 I - 13 II - 4 III - 13 IV - 1 All rectal cancer
Pigazzi (2006)	R (Hybrid)	60	4:2	104	4.5	14	264	0	TME	Rectal CA, stages unspecified
Kwak	R	60	39:20	---	---	20	270	0	LAR - 54 IS - 5 APR - 0	0 - 3 I - 16 II - 23 III - 13 IV - 4 Rectal CA
Koh	R	61	13:8	---	6.4	17.8	316	0	APR - 1 Anterior resection - 7 LAR - 7 Ultralow anterior resection - 5 Sigmoid resection & rectopexy -1	I - 3 II - 6 III - 5 IV - 3 No cancer found - 2
Patel	R (Hybrid)	58.8	3:2	150	5.4	7	204	0	TME	I - 14 II - 4 III - 7 Rectal CA
Baek	R	63.6	25:16	200	6.5	13.1	296	3	LAR - 33 CA - 2 APR - 6	Rectal CA 0 - 7 I - 12 II - 4 III - 15 IV - 3
Pigazzi (2010)	R (Hybrid)	62	87:56	283	8:3	14.1	297	7	Unspecified number of IS vs APR	Rectal CA 0 - 18 I - 36 II - 36 III - 53
Spinoglio	R	66.7	32:18	---	7.74	22.03	384	2	R Hemi - 18 L Hemi - 10 Rectal anterior resection w/ total proctectomy - 19	0 - 3 I - 36 II - 24 III - 28 IV - 9
Choi	R	58.5	38:12	---	9.2	20.6	304	0	TME	Rectal CA 0 - 0 I - 10 II - 19 III - 19 IV - 2
Baik(2009)	R (Hybrid)	60.3	37:19	---	5.7	18.4	190	0	TME	I - 22 II - 16 III - 18
Pigazzi (2006)	L	70	2:4	150	3.6	17	258	0	---	Rectal CA, stages unspecified
Kwak	L	59	42:17	---	---	21	228	2	LAR- 52 APR- 6 IS- 1	0 - 3 I - 16 II - 23 III - 12 IV - 5
Bianchi	L	62	17:8	---	6	17	237	1	---	I - 14 II -7 III - 4
Baek	L	63.7	26:16	300	6.6	16.2	315	9	LAR - 33 CA - 2 APR - 6	0 - 3 I - 15 II - 3 III - 19 IV - 1
Spinoglio	L	68.8	74:86	---	8.31	22.85	266	4	---	0 - 4.8 I - 19.3 II - 33.7 III - 28.9 IV - 13.3
Baik	L	63.2	34:23	---	7.6	18.7	191	6	---	I - 14 II - 19 III - 24
Bianchi	R	69	18:7	---	6.5	18	240	0	TME	I - 14 II - 4 III - 7 Rectal CA

*Hybrid studies used laparoscope for early dissection (establishing pneumoperitoneum to mobilization of splenic flexure), w/ robot then used for rectal mobilization and TME **Values reported as median; LAR - Low anterior resection, APR - abdominoperineal resection, CA - coloanal, IS - intersphinteric