Preservation of Pathologic Outcomes in Robotic versus Open Resection for Rectal Cancer: Can the Robot Fill the Minimally Invasive Gap?

Open resection remains the standard of care in the surgical management of rectal cancer with recent studies unable to prove noninferiority of laparoscopic resection. Few studies directly compare robotic versus open techniques. This is a retrospective chart review of all consecutive patients undergoing robotic or open rectal cancer resection during a three-year period. The primary endpoint was a composite of complete mesorectal excision, circumferential resection margin <1 mm, and distal resection margin <1 mm. The study cohort included 64 patients undergoing robotic (n = 28) or open (n = 36) resection. Successful surgical resection was similar between the robotic (75%) and open (76%) approaches. Robotic resection was associated with significantly lower blood loss ( P = 0.02) and significantly longer operative times ( P = 0.009) compared with open resection. Length of hospital stay and complications were similar between groups. Both male gender ( P = 0.03) and shorter tumor distance from the anal verge ( P = 0.01) were predictors for unsuccessful surgical resection in open, but not robotic, surgery. Pathologic outcomes are similar between robotic and open rectal cancer resection, even early in the learning curve. Tumor distance from the anal verge complicates open total mesorectal excision; however, robotic surgery is less impacted. Robotic resection may be a promising minimally invasive approach for rectal cancer resection.

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Superior pathologic and clinical outcomes after minimally invasive rectal cancer resection, compared to open resection

Surgical Endoscopy ◽

10.1007/s00464-019-07120-2 ◽

2019 ◽

Vol 34 (8) ◽

pp. 3435-3448 ◽

Cited By ~ 1

Author(s):

Grace C. Lee ◽

Liliana G. Bordeianou ◽

Todd D. Francone ◽

Lawrence S. Blaszkowsky ◽

Robert N. Goldstone ◽

...

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Clinical Outcomes ◽

Open Resection ◽

Cancer Resection ◽

Rectal Cancer Resection

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Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection

Colorectal Disease ◽

10.1111/codi.14742 ◽

2019 ◽

Vol 21 (12) ◽

pp. 1364-1371 ◽

Cited By ~ 2

Author(s):

B. Creavin ◽

É. J. Ryan ◽

M. E. Kelly ◽

A. Moynihan ◽

C. E. Redmond ◽

...

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Anastomotic Leakage ◽

Cancer Resection ◽

Rectal Cancer Resection

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LARS is Associated with Lower Anastomoses, but not with the Transanal Approach in Patients Undergoing Rectal Cancer Resection

World Journal of Surgery ◽

10.1007/s00268-020-05876-6 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alexandra Filips ◽

Tobias Haltmeier ◽

Andreas Kohler ◽

Daniel Candinas ◽

Lukas Brügger ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Functional Outcomes ◽

Low Anterior Resection ◽

Regression Coefficient ◽

Anal Verge ◽

Transanal Approach ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

The Impact

Abstract Background Low anterior resection syndrome (LARS) is a defecation disorder that frequently occurs after a low anterior resection (LAR) with a total mesorectal excision (TME). The transanal (ta) TME for low rectal pathologies could potentially overcome some of the difficulties encountered with the abdominal approach in a narrow pelvis. However, the impact of the transanal approach on functional outcomes remains unknown. Here, we investigated the effect of the taTME approach on functional outcomes by comparing LARS scores between the LAR and taTME approaches in patients with colorectal cancer. Methods We conducted a retrospective cohort study including 80 patients (n = 40 LAR-TME, n = 40 taTME) with rectal adenocarcinoma. We reviewed medical charts to obtain LARS scores 6 months after the rectal resection or a reversal of the protective ileostomy. Results At the 6-month follow-up, 80% of patients exhibited LARS symptoms (44% minor LARS and 36% major LARS). LARS scores were not significantly associated with the T-stage, N-stage, or neo-adjuvant radiotherapy. The mean distance of the anastomosis from the anal verge was 4.0 ± 2.0 cm. The taTME group had significantly lower anastomoses compared with the LAR-TME group (median 4.0 cm [IQR1.8] vs. median 5.0 cm [IQR 2.0], p < 0.001). Univariable analysis revealed significantly higher LARS scores in the taTME group compared with the LAR-TME group (median LARS scores: 29 vs. 25, p = 0.040). However, multivariable regression analysis, adjusting for neo-adjuvant treatment, anastomosis distance from the anal verge, anastomotic leak rate, and body mass index, revealed no significant effect of taTME on the LARS score (adjusted regression coefficient: − 2.147, 95%CI: − 2.130 to 6.169, p = 0.359). We also found a significant correlation between LARS scores and the distance of the anastomosis from the anal verge (regression coefficient: − 1.145, 95%CI: − 2.149 to − 1.141, p = 0.026). Conclusion Fifty percentage of patients in this cohort exhibited some LARS symptoms after a mid- or low-rectal cancer resection. As previously described, LARS scores were negatively correlated with the distance of the anastomosis from the anal verge. TaTME was after adjustment for the height of the anastomosis not associated with higher LARS at 6 months when compared with LAR-TME.

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Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection

International Journal of Colorectal Disease ◽

10.1007/s00384-014-1846-6 ◽

2014 ◽

Vol 29 (5) ◽

pp. 585-590 ◽

Cited By ~ 11

Author(s):

G. S. Simpson ◽

N. Eardley ◽

F. McNicol ◽

P. Healey ◽

M. Hughes ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Treatment ◽

Circumferential Resection Margin ◽

Resection Margin ◽

Cancer Resection ◽

Rectal Cancer Resection

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Update on Robotic Total Mesorectal Excision for Rectal Cancer

Journal of Personalized Medicine ◽

10.3390/jpm11090900 ◽

2021 ◽

Vol 11 (9) ◽

pp. 900

Author(s):

Simona Giuratrabocchetta ◽

Giampaolo Formisano ◽

Adelona Salaj ◽

Enrico Opocher ◽

Luca Ferraro ◽

...

Keyword(s):

Rectal Cancer ◽

Robotic Surgery ◽

Minimally Invasive ◽

Total Mesorectal Excision ◽

Indirect Costs ◽

Population Based ◽

Complication Rates ◽

Mesorectal Excision ◽

Invasive Treatment ◽

Multicenter Studies

The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one of the main drawbacks of robotic surgery, should be thoroughly evaluated including both the direct and indirect costs, with the latter having the potential of counterbalancing the excess of expenditure directly related to the purchase and maintenance of robotic equipment. Further prospectively maintained or randomized data are still required to better delineate the advantages of the robotic platform, especially in the subset of most complex and technically challenging patients from both an anatomical and oncological standpoint.

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Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases

Indian Journal of Surgical Oncology ◽

10.1007/s13193-020-01212-5 ◽

2020 ◽

Vol 11 (4) ◽

pp. 653-661

Author(s):

C. Ramachandra ◽

Pavan Sugoor ◽

Uday Karjol ◽

Ravi Arjunan ◽

Syed Altaf ◽

...

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Total Mesorectal Excision ◽

Resection Margin ◽

Da Vinci ◽

Rectal Resection ◽

Mesorectal Excision ◽

Short Term ◽

Oncological Outcomes ◽

Duration Of Surgery

AbstractEmerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon.

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Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000200008 ◽

2015 ◽

Vol 28 (2) ◽

pp. 117-120 ◽

Cited By ~ 3

Author(s):

Carlos Ramon Silveira MENDES ◽

Marcus VALADÃO ◽

Rodrigo ARAÚJO ◽

Eduardo LINHARES ◽

José Paulo JESUS

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Total Mesorectal Excision ◽

Anal Verge ◽

Rectal Adenocarcinoma ◽

Invasive Procedure ◽

Oncological Outcome ◽

Lower Rectal Cancer ◽

Mesorectal Excision ◽

Transanal Resection

RATIONAL: In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge. AIM: To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer. METHOD: The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM). RESULT: The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision). CONCLUSION: This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.

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