Treffer: Impact of the learning curve on the outcomes of robotic surgery in obese patients with rectal cancer.
Title:
Impact of the learning curve on the outcomes of robotic surgery in obese patients with rectal cancer.
Authors:
Izukawa S; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan., Numata M; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan. numata@yokohama-cu.ac.jp., Fukuda T; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan., Harada T; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan., Atsumi Y; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan., Kazama K; Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0004, Japan., Sawazaki S; Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0004, Japan., Suzuki S; Department of Surgery, Fujisawa Shonandai Hospital, 2345, Takakura, Fujisawa-City, Kanagawa, 252-0802, Japan., Godai T; Department of Surgery, Fujisawa Shonandai Hospital, 2345, Takakura, Fujisawa-City, Kanagawa, 252-0802, Japan., Higuchi A; Department of Surgery, Yokohama Minami Kyosai Hospital, 21-1, Mutsuurahigashi, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0037, Japan., Tamagawa H; Department of Surgery, Yokohama Minami Kyosai Hospital, 21-1, Mutsuurahigashi, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0037, Japan., Suwa Y; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan., Watanabe J; Department of Colorectal Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata-City, , Osaka, 573-1010, Japan., Sato T; Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama-City, Kanagawa, 232-0024, Japan., Saito A; Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0004, Japan.
Source:
Surgery today [Surg Today] 2026 Jan; Vol. 56 (1), pp. 36-46. Date of Electronic Publication: 2025 Sep 02.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Springer International Country of Publication: Japan NLM ID: 9204360 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1436-2813 (Electronic) Linking ISSN: 09411291 NLM ISO Abbreviation: Surg Today Subsets: MEDLINE
Imprint Name(s):
Original Publication: Tokyo : Springer International, c1992-
MeSH Terms:
Learning Curve* , Rectal Neoplasms*/surgery , Rectal Neoplasms*/complications , Robotic Surgical Procedures*/education , Robotic Surgical Procedures*/methods , Obesity*/complications , Operative Time*, Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Treatment Outcome ; Aged ; Blood Loss, Surgical/statistics & numerical data ; Propensity Score ; Time Factors
References:
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Schiphorst AHW, Verweij NM, Pronk A, Borel Rinkes IHM, Hamaker ME. Non-surgical complications after laparoscopic and open surgery for colorectal cancer - a systematic review of randomised controlled trials. Eur J Surg Oncol. 2015;41:1118–27. (PMID: 10.1016/j.ejso.2015.04.00725980746)
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E. Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg. 2008;95:903–8. (PMID: 10.1002/bjs.613418551506)
Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;269:589–95. (PMID: 10.1097/SLA.000000000000300230080730)
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Kashihara H, Shimada M, Yoshikawa K, Higashijima J, Tokunaga T, Nishi M, et al. The influence and countermeasure of obesity in laparoscopic colorectal resection. Ann Gastroenterol Surg. 2021;5:677–82. (PMID: 10.1002/ags3.12455345850528452473)
Peacock O, Limvorapitak T, Hu C-Y, Bednarski BK, Tillman MM, Kaur H, et al. Robotic rectal cancer surgery: comparative study of the impact of obesity on early outcomes. Br J Surg. 2020;107:1552–7. (PMID: 32996597)
Lagares-Garcia J, O’Connell A, Firilas A, Robinson CC, Dumas BP, Hagen ME. The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery. Int J Med Robot. 2016;12:680–5. (PMID: 10.1002/rcs.169526314561)
Bayraktar O, Aytaç E, Özben V, Atasoy D, Bilgin İsmailA, Erenler Bayraktar İ, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech. 2018;28:e8–11. (PMID: 10.1097/SLE.000000000000050029252933)
Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, et al. Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc. 2015;29:1679–85. (PMID: 10.1007/s00464-014-3855-525277477)
Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25:855–60. (PMID: 10.1007/s00464-010-1281-x20734081)
Jiménez-Rodríguez RM, Rubio-Dorado-Manzanares M, Díaz-Pavón JM, Reyes-Díaz ML, Vazquez-Monchul JM, Garcia-Cabrera AM, et al. Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Colorectal Dis. 2016;31:1807–15. (PMID: 10.1007/s00384-016-2660-027714517)
Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen Y-J, Ciombor KK, et al. Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021;19:329–59. (PMID: 10.6004/jnccn.2021.001233724754)
World Health Organization. BMI classification. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html . Accessed September 29, 2017.
Li H, Boakye D, Chen X, Jansen L, Chang-Claude J, Hoffmeister M, et al. Associations of body mass index at different ages with early-onset colorectal cancer. Gastroenterology. 2022;162:1088–97. (PMID: 10.1053/j.gastro.2021.12.23934914944)
Yamashita M, Tominaga T, Nonaka T, Fukuda A, Moriyama M, Oyama S, et al. Impact of obesity on short-term outcomes of laparoscopic colorectal surgery for Japanese patients with colorectal cancer: A multicenter study. Asian J Endosc Surg. 2021;14:432–42. (PMID: 10.1111/ases.1288833111467)
Numata M, Sawazaki S, Kazama K, Aoyama T, Tamagawa H, Sato T, et al. A seven-step dissection technique for robotic total mesorectal excision of rectal cancer. Tech Coloproctol. 2019;23:913–8. (PMID: 10.1007/s10151-019-02081-z31522291)
Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2022 for the treatment of colorectal cancer.
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8. (PMID: 10.1038/bmt.2012.24423208313)
Bayraktar O, Aytaç E, Özben V, Atasoy D, Bilgin İsmailA, Erenler Bayraktar İ, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech. 2018;28: e8–e11. (PMID: 29252933)
Hamabe A, Takemasa I, Kotake M, Nakano D, Hasegawa S, Shiomi A, et al. Feasibility of robotic-assisted surgery in advanced rectal cancer: a multicentre prospective phase II study (VITRUVIANO trial). BJS Open. 2024;8: zrae048. (PMID: 10.1093/bjsopen/zrae0483891341911195309)
Miyamoto Y, Ishii T, Tashiro Jo, Satoh T, Watanabe M, Baba H, et al. Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer. Surg Today. 2014;44:1293–9. (PMID: 10.1007/s00595-013-0718-y24185897)
Examination Committee of Criteria for “Obesity Disease” in Japan, Japan Society for the Study of Obesity. New criteria for obesity in Japan. Circ J. 2002;66:987–92. (PMID: 10.1253/circj.66.987)
Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2:261–8. (PMID: 10.1016/S2468-1253(16)30207-228404155)
Schwandner O, Farke S, Schiedeck THK, Bruch H-P. Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc. 2004;18:1452–6. (PMID: 10.1007/s00464-003-9259-615791368)
Bège T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero J-R. Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc. 2009;23:1460–4. (PMID: 10.1007/s00464-008-0266-519116737)
Zhou Y, Wu L, Li X, Wu X, Li B. Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc. 2012;26:783–9. (PMID: 10.1007/s00464-011-1952-222011944)
Yamamoto S, Fukunaga M, Miyajima N, Okuda J, Konishi F, Watanabe M, Japan Society of Laparoscopic Colorectal Surgery. Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients. J Am Coll Surg. 2009;208:383–9. (PMID: 10.1016/j.jamcollsurg.2008.12.00219318000)
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;318:1569–80. (PMID: 10.1001/jama.2017.7219290674265818805)
Harr JN, Luka S, Kankaria A, Juo Y-Y, Agarwal S, Obias V. Robotic-assisted colorectal surgery in obese patients: a case-matched series. Surg Endosc. 2017;31:2813–9. (PMID: 10.1007/s00464-016-5291-127796599)
Hannan E, Troy A, Feeney G, Ullah MF, Ryan C, McNamara E, et al. The impact of body mass index on outcomes in robotic colorectal surgery: a single-centre experience. J Robot Surg. 2022;16:279–85. (PMID: 10.1007/s11701-021-01235-233813713)
Shiomi A, Kinugasa Y, Yamaguchi T, Kagawa H, Yamakawa Y. Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis. 2016;31:1701–10. (PMID: 10.1007/s00384-016-2653-z27599703)
Conti C, Pedrazzani C, Turri G, Gecchele G, Valdegamberi A, Ruzzenente A, et al. Visceral obesity enhances inflammatory response after laparoscopic colorectal resection. Int J Clin Pract. 2021;75: e14795. (PMID: 10.1111/ijcp.1479534482612)
Feng Q, Yuan W, Li T, Tang Bo, Jia B, Zhou Y, et al.: REAL Study Group. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7:991–1004. (PMID: 10.1016/S2468-1253(22)00248-536087608)
Sng KK, Hara M, Shin J-W, Yoo B-E, Yang K-S, Kim S-H. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc. 2013;27:3297–307. (PMID: 10.1007/s00464-013-2909-423508818)
Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis. 2014;29:343–51. (PMID: 10.1007/s00384-013-1803-924297037)
Kajiwara Y, Takahashi A, Ueno H, Kakeji Y, Hasegawa H, Eguchi S, et al. Annual report on National Clinical Database 2020 for gastroenterological surgery in Japan. Ann Gastroenterol Surg. 2023;7:367–406. (PMID: 10.1002/ags3.126623715277610154850)
Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24. (PMID: 10.1002/bjs.464015449261)
Seishima R, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Matsui S, et al. Is laparoscopic colorectal surgery beneficial for elderly patients? A systematic review and meta-analysis. J Gastrointest Surg. 2015;19:756–65. (PMID: 10.1007/s11605-015-2748-925617077)
Schiphorst AHW, Verweij NM, Pronk A, Borel Rinkes IHM, Hamaker ME. Non-surgical complications after laparoscopic and open surgery for colorectal cancer - a systematic review of randomised controlled trials. Eur J Surg Oncol. 2015;41:1118–27. (PMID: 10.1016/j.ejso.2015.04.00725980746)
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E. Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg. 2008;95:903–8. (PMID: 10.1002/bjs.613418551506)
Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;269:589–95. (PMID: 10.1097/SLA.000000000000300230080730)
Australasian Gastro-Intestinal Trials Group (AGITG) ALaCaRT investigators, Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg. 2019;269:596–602. (PMID: 10.1097/SLA.0000000000003021)
Kashihara H, Shimada M, Yoshikawa K, Higashijima J, Tokunaga T, Nishi M, et al. The influence and countermeasure of obesity in laparoscopic colorectal resection. Ann Gastroenterol Surg. 2021;5:677–82. (PMID: 10.1002/ags3.12455345850528452473)
Peacock O, Limvorapitak T, Hu C-Y, Bednarski BK, Tillman MM, Kaur H, et al. Robotic rectal cancer surgery: comparative study of the impact of obesity on early outcomes. Br J Surg. 2020;107:1552–7. (PMID: 32996597)
Lagares-Garcia J, O’Connell A, Firilas A, Robinson CC, Dumas BP, Hagen ME. The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery. Int J Med Robot. 2016;12:680–5. (PMID: 10.1002/rcs.169526314561)
Bayraktar O, Aytaç E, Özben V, Atasoy D, Bilgin İsmailA, Erenler Bayraktar İ, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech. 2018;28:e8–11. (PMID: 10.1097/SLE.000000000000050029252933)
Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, et al. Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc. 2015;29:1679–85. (PMID: 10.1007/s00464-014-3855-525277477)
Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25:855–60. (PMID: 10.1007/s00464-010-1281-x20734081)
Jiménez-Rodríguez RM, Rubio-Dorado-Manzanares M, Díaz-Pavón JM, Reyes-Díaz ML, Vazquez-Monchul JM, Garcia-Cabrera AM, et al. Learning curve in robotic rectal cancer surgery: current state of affairs. Int J Colorectal Dis. 2016;31:1807–15. (PMID: 10.1007/s00384-016-2660-027714517)
Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen Y-J, Ciombor KK, et al. Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021;19:329–59. (PMID: 10.6004/jnccn.2021.001233724754)
World Health Organization. BMI classification. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html . Accessed September 29, 2017.
Li H, Boakye D, Chen X, Jansen L, Chang-Claude J, Hoffmeister M, et al. Associations of body mass index at different ages with early-onset colorectal cancer. Gastroenterology. 2022;162:1088–97. (PMID: 10.1053/j.gastro.2021.12.23934914944)
Yamashita M, Tominaga T, Nonaka T, Fukuda A, Moriyama M, Oyama S, et al. Impact of obesity on short-term outcomes of laparoscopic colorectal surgery for Japanese patients with colorectal cancer: A multicenter study. Asian J Endosc Surg. 2021;14:432–42. (PMID: 10.1111/ases.1288833111467)
Numata M, Sawazaki S, Kazama K, Aoyama T, Tamagawa H, Sato T, et al. A seven-step dissection technique for robotic total mesorectal excision of rectal cancer. Tech Coloproctol. 2019;23:913–8. (PMID: 10.1007/s10151-019-02081-z31522291)
Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2022 for the treatment of colorectal cancer.
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8. (PMID: 10.1038/bmt.2012.24423208313)
Bayraktar O, Aytaç E, Özben V, Atasoy D, Bilgin İsmailA, Erenler Bayraktar İ, et al. Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech. 2018;28: e8–e11. (PMID: 29252933)
Hamabe A, Takemasa I, Kotake M, Nakano D, Hasegawa S, Shiomi A, et al. Feasibility of robotic-assisted surgery in advanced rectal cancer: a multicentre prospective phase II study (VITRUVIANO trial). BJS Open. 2024;8: zrae048. (PMID: 10.1093/bjsopen/zrae0483891341911195309)
Miyamoto Y, Ishii T, Tashiro Jo, Satoh T, Watanabe M, Baba H, et al. Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer. Surg Today. 2014;44:1293–9. (PMID: 10.1007/s00595-013-0718-y24185897)
Examination Committee of Criteria for “Obesity Disease” in Japan, Japan Society for the Study of Obesity. New criteria for obesity in Japan. Circ J. 2002;66:987–92. (PMID: 10.1253/circj.66.987)
Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2:261–8. (PMID: 10.1016/S2468-1253(16)30207-228404155)
Schwandner O, Farke S, Schiedeck THK, Bruch H-P. Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc. 2004;18:1452–6. (PMID: 10.1007/s00464-003-9259-615791368)
Bège T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero J-R. Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc. 2009;23:1460–4. (PMID: 10.1007/s00464-008-0266-519116737)
Zhou Y, Wu L, Li X, Wu X, Li B. Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc. 2012;26:783–9. (PMID: 10.1007/s00464-011-1952-222011944)
Yamamoto S, Fukunaga M, Miyajima N, Okuda J, Konishi F, Watanabe M, Japan Society of Laparoscopic Colorectal Surgery. Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients. J Am Coll Surg. 2009;208:383–9. (PMID: 10.1016/j.jamcollsurg.2008.12.00219318000)
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;318:1569–80. (PMID: 10.1001/jama.2017.7219290674265818805)
Harr JN, Luka S, Kankaria A, Juo Y-Y, Agarwal S, Obias V. Robotic-assisted colorectal surgery in obese patients: a case-matched series. Surg Endosc. 2017;31:2813–9. (PMID: 10.1007/s00464-016-5291-127796599)
Hannan E, Troy A, Feeney G, Ullah MF, Ryan C, McNamara E, et al. The impact of body mass index on outcomes in robotic colorectal surgery: a single-centre experience. J Robot Surg. 2022;16:279–85. (PMID: 10.1007/s11701-021-01235-233813713)
Shiomi A, Kinugasa Y, Yamaguchi T, Kagawa H, Yamakawa Y. Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis. 2016;31:1701–10. (PMID: 10.1007/s00384-016-2653-z27599703)
Conti C, Pedrazzani C, Turri G, Gecchele G, Valdegamberi A, Ruzzenente A, et al. Visceral obesity enhances inflammatory response after laparoscopic colorectal resection. Int J Clin Pract. 2021;75: e14795. (PMID: 10.1111/ijcp.1479534482612)
Feng Q, Yuan W, Li T, Tang Bo, Jia B, Zhou Y, et al.: REAL Study Group. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7:991–1004. (PMID: 10.1016/S2468-1253(22)00248-536087608)
Sng KK, Hara M, Shin J-W, Yoo B-E, Yang K-S, Kim S-H. The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc. 2013;27:3297–307. (PMID: 10.1007/s00464-013-2909-423508818)
Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis. 2014;29:343–51. (PMID: 10.1007/s00384-013-1803-924297037)
Contributed Indexing:
Keywords: Learning curve; Obese patients; Rectal cancer; Robotic surgery
Entry Date(s):
Date Created: 20250902 Date Completed: 20260116 Latest Revision: 20260116
Update Code:
20260117
DOI:
10.1007/s00595-025-03113-y
PMID:
40892105
Database:
MEDLINE
Weitere Informationen
Purpose: One of the challenges in performing surgery on obese patients with rectal cancer is the prolonged operation time. This study investigates whether or not this issue can be overcome through the surgeon's learning curve as they become proficient in robotic surgery.
Methods: A retrospective review of 396 consecutive robotic procedures. The cases were divided into a learning phase (LP) group (first 20 cases) and a stabilized phase (SP) group (from case 21 onward). Patients were divided into obese (BMI ≥ 25 kg/m <sup>2</sup> ) and non-obese groups using 1:1 propensity score matching. This resulted in 130 and 72 patients in the LP and SP groups, respectively. The primary endpoint of this study was operation time.
Results: In the LP group, obese patients had significantly longer operative times (329 min vs. 289 min) and greater blood loss (10 g [0-50] vs. 10 g [0-12]) than non-obese patients. In the SP group, the perioperative outcomes, including operation time, were similar between the two patient groups.
Conclusion: This study suggests that during the early phase of the learning curve, operation time may be prolonged in obese patients. However, once the learning curve stabilizes, the issue of prolonged operative time can be overcome.
(© 2025. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)
Declarations. Conflict of interest: Shota Izukawa and other co-authors have no conflict of interest.