Original Title: Robotassistert rektumreseksjon ved endetarmskreft: En fullstendig metodevurdering

Authors' objectives: The purpose of this health technology assessment (HTA) was to evaluate the clinical effects and to conduct a health economic evaluation of robot-assisted rectal resection for rectal cancer. Robot-assisted technique was compared to traditional laparoscopic and open surgery. We have also described organizational aspects of robot-assisted surgery.

Authors' results and conclusions: For the comparison of robot-assisted and laparoscopic surgery, we included six RCTs (2,459 patients) and 20 non-RCTs (50,237 patients, with some overlap in study population). The patients in the RCTs were mainly from Asia, while patients in non-RCTs were from the USA, Asia, Australia, and several European countries, including Norway. We found that robot-assisted rectal resection led to fewer conversions to open surgery (Summary Table). Furthermore, robot-assisted surgery probably resulted in longer operating time, shorter length of stay and fewer patients with circumferential margin positivity than traditional laparoscopy. There were probably no differences in short-term complications or bladder function between the groups. There was small or no difference in long-term survival, but we have low confidence in the results. There was also uncertainty related to the results for reoperations and short-term mortality. It was not possible to assess how robot-assisted surgery affected sexual function based on available documentation. For the comparison of robot-assisted and open surgery, we identified five non-RCTs. All the studies were from one patient registry (USA), and only some of the outcomes of interest were reported. We found that robot-assisted rectal resection led to shorter length of stay and fewer patients with circumferential margin positivity compared to open surgery, but we have low confidence in the results. It was not possible to assess how robot-assisted surgery affected short-term mortality or long-term survival based on the available documentation.

Authors' methods: We conducted a systematic literature search in relevant databases. Two researchers assessed titles, abstracts, and full-text publications of potentially relevant references against the inclusion criteria. Studies of learning curve or first experiences with robotic surgery were excluded. We included randomized trials (RCTs) and non-randomized trials with control groups (non-RCTs) and compiled the results in separate meta-analyses. Two researchers assessed risk of bias and assessed confidence in the results using GRADE. We performed a simplified health economic assessment, where we collected investment costs and costs per hospital stay (KPP) for the surgical techniques. We present examples of organization from three Norwegian hospitals.

Project Status: Completed

URL for project: https://www.fhi.no/en/cristin-projects/ongoing/robot-assisted-rectal-resection-for-rectal-cancer/

Year Published: 2024

URL for published report: https://www.fhi.no/en/publ/2024/Robot-assisted-rectal-resection-for-rectal-cancer/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: P.O. Box 222 Skoyen, N-0123, Oslo