Recommendation for NHSScotland

Robot-assisted surgery should be considered for patients with rectal cancer who have a narrow pelvis, are obese (BMI≥30), and/or have a tumour located in the mid-to-low rectum. There is evidence of a clinical benefit in the form of reduced risk of conversion to open surgery in these patients, although relevant cost-effectiveness evidence is currently lacking. Expert opinion indicates that conventional laparoscopic options are inadequate for these patients.

Data on clinical, oncological and patient-important outcomes should be collected for all robot-assisted surgeries in patients with rectal cancer who meet the criteria outlined above.

Provision of robot-assisted surgery for rectal cancer should be concentrated within centres that currently have a robotic surgical device and are likely to be receive a sufficient number of suitable patients per year to maintain surgeon proficiency.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

We were asked to provide advice on the use of robot-assisted surgery for the treatment of rectal cancer, based on the published evidence and a patient organisation submission.  

Why is this important?

Da Vinci® robotic surgical devices are a relatively new technology which is available at four centres in NHSScotland. These devices are currently used predominantly to provide a laparoscopic prostatectomy service. To ensure the devices are optimally employed, NHSScotland is considering expanding the indications for which robot-assisted surgery is available.

Referred by 

NHS Greater Glasgow and Clyde