To the Editor The Robotic vs Laparoscopic Resection for Rectal Cancer randomized clinical trial1 did not demonstrate any benefit for robotic rectal resection compared with conventional laparoscopic resection. Despite the randomized design of the study, we have questions about the reliability of the results.
First, the experience in robotic surgery of the surgeons involved is questionable. Some were still in the learning phase, resulting in a nonhomogeneous number of procedures performed per center. In 2 sites, only 2 patients were enrolled, whereas the highest number was 35 procedures in Finland. Because a 1:1 randomization was applied, a mean of only 8.2 robotic resections per center were performed. This low number of procedures cannot be considered sufficient to draw conclusions about the effectiveness of the robotic approach because a high-volume center performs at least 20 to 30 procedures per year.2,3 This lack of experience also may have been reflected in the fact that a significant number of procedures was performed as a hybrid approach, in which the robot was docked only for pelvic dissection.
Alfieri S, Quero G, Parvaiz A. Robotic-Assisted vs Conventional Laparoscopic Surgery for Rectal Cancer. JAMA. 2018;319(11):1163–1164. doi:10.1001/jama.2017.21692
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