Single-Docking Full Robotic Surgery for Rectal Cancer: A Single-Center Experience

2018 ◽  
Vol 25 (3) ◽  
pp. 258-266 ◽  
Author(s):  
Sergio Alfieri ◽  
Dario Di Miceli ◽  
Roberta Menghi ◽  
Caterina Cina ◽  
Claudio Fiorillo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Conversion Rate ◽  
Disease Free Survival ◽  
Perioperative Outcomes ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Anterior Rectal Resection ◽  
Disease Free

Purpose. Robotic surgery has gradually gained importance in the treatment of rectal cancer. However, recent studies have not shown any advantages when compared with laparoscopy. The objective of this study is to report a single surgeon’s experience in robotic rectal surgery focusing on short-term and long-term outcomes. Methods. Sixty consecutive robotic rectal resections for adenocarcinoma, over a 4-year period, were retrospectively reviewed. Patients’ characteristics and perioperative outcomes were analyzed. Oncological outcomes and surgical resection quality as well as overall and disease-free survival were also assessed. Results. Thirty patients out of 60 (50%) underwent neoadjuvant therapy. Anterior rectal resection was performed in 52 cases (86.7%), and abdominoperineal resection was done in 8 cases (13.3%). Mean operative time was 283 (±68.6) minutes. The conversion rate was 5% (3 patients). Postoperative complications occurred in 10 cases (16.7%), and reoperation was required in 1 case (1.7%). Mean hospital stay was 9 days, while 30-day mortality was 1.7% (1 patients). The histopathological analysis reported a negative circumferential radial margin and distal margins in 100% of cases with a complete or near complete total mesorectal excision in 98.3% of patients. Mean follow-up was 32.8 months with a recurrence rate of 3.4% (2 patients). Overall survival and disease-free survival were 94% and 87%, respectively. Conclusions. Robotic surgery for rectal cancer proves to be safe and feasible when performed by highly skilled surgeons. It offers acceptable perioperative outcomes with a conversion rate notably lower than with the laparoscopic approach. Adequate pathological results and long-term oncological outcomes were also obtained.

Comparison of long-term survival outcomes between laparoscopic and open surgery for mid or low rectal cancer treated with preoperative chemoradiotherapy: 7-year follow-up of COREAN trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3518-3518
Author(s):  
Ji Won Park ◽  
Seung-Yong Jeong ◽  
Sung-Bum Kang ◽  
Jungnam Joo ◽  
Mi Kyung Song ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Local Recurrence ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Preoperative Chemoradiotherapy ◽  
Low Rectal Cancer ◽  
Free Survival ◽  
Disease Free

3518 Background: Laparoscopic surgery for rectal cancer has been used widely. However, recent two randomized trials raised concerns about short-term oncologic safety of laparoscopic surgery for rectal cancer. The aim of this study was to evaluate the long-term oncologic safety of laparoscopic surgery for rectal cancer based on 7-year data from the Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial. Methods: COREAN trial was a non-inferiority, randomized controlled trial. Between April, 2006, and Aug, 2009, eligible participants with mid or low rectal cancer treated with preoperative chemoradiotherapy were randomly assigned (1:1) to laparoscopic (n = 170) or open surgery (n = 170). Seven-year outcomes included overall and disease-free survival, and local recurrence. Log-rank test and stratified Cox regression analysis were used for survival analysis. Analysis was by intention to treat. Results: The median follow-up times were 84 months (IQR: 61.5-97.0). No differences were found between laparoscopic and open surgery group in terms of overall and disease-free survival, and local recurrence (7-year overall survival: 83.2% [laparoscopic] vs 77.3% [open], p = 0.48; 7-year disease-free survival: 71.6% [laparoscopic] vs 64.3% [open], p = 0.20; 7-year local recurrence: 3.3% [laparoscopic] vs 7.9% [open], p = 0.08). Stratified Cox regression analysis adjusted for ypT, ypN and tumor regression grade showed no significant difference between groups in terms of overall and disease-free survival, and local recurrence. The hazard ratios for overall survival, disease-free survival and local recurrence (open vs laparoscopic surgery) were 0.96 (95% CI = 0.58-1.57), 1.03 (95% CI = 0.70-1.53), and 2.28 (95% CI = 0.82-7.16), respectively. Conclusions: The 7-year analysis confirm the long-term oncological safety of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. The use of laparoscopic surgery does not compromise the long-term survival outcomes in rectal cancer. Clinical trial information: NCT00470951.

scholarly journals A Case of Long-term Disease-free Survival after Radiotherapy for Locally Recurrent Rectal Cancer

2013 ◽  
Vol 66 (6) ◽  
pp. 416-421
Author(s):  
Nobuyoshi Yamazaki ◽  
Akihiro Kobayashi ◽  
Yusuke Nishizawa ◽  
Masaaki Ito ◽  
Masanori Sugito ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Disease Free Survival ◽  
Recurrent Rectal Cancer ◽  
Free Survival ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent ◽  
Disease Free

Evolving Role of Hepatic Resection for Metastatic Urologic Malignancies

2017 ◽  
Vol 83 (6) ◽  
pp. 628-632 ◽  
Author(s):  
John B. Hamner ◽  
Mustafa Raoof ◽  
Sinziana Dumitra ◽  
Hans F. Schoellhammer ◽  
Carly Crowder ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hepatic Resection ◽  
Disease Free Survival ◽  
Perioperative Outcomes ◽  
R0 Resection ◽  
Term Survival ◽  
Free Survival ◽  
Urologic Malignancies ◽  
Disease Free

Liver resection for noncolorectal, nonneuroendocrine metastases remains controversial. Here, we evaluate a single institutional experience with hepatic resection for metastatic urologic malignancies. A single-institution review of patients who underwent hepatic resection for metastatic urologic tumors between the years of 2000 and 2013 was performed. Patient charts were analyzed for pathologic data and perioperative outcomes including short- and long-term morbidity, mortality, and overall and disease-free survival. Eleven patients were identified who underwent hepatic resection for metastatic urologic malignancy. The mean age was 63.5 years. All patients had an R0 resection. There were three major complications. Mean length of stay was 6.5 days and there was no 90-day mortality. Three patients have died of recurrent disease at an average of 11.2 months from resection to death. The remaining patients are still alive during a mean follow-up of 31.5 months. Five-year overall and disease-free survival was 50 and 21 months, respectively. Hepatic resection for metastatic urologic tumors is safe with low morbidity and mortality and durable long-term survival can be achieved. Liver resection for isolated hepatic disease should be considered for this rare metastatic disease to the liver.

scholarly journals Oncological outcomes of obstructed locally advanced rectal cancer in the era of multi-modal therapy

2018 ◽  
Vol 5 (11) ◽  
pp. 3695
Author(s):  
Joshua Franklyn ◽  
Gigi Varghese ◽  
Rajat Rghunath ◽  
Tunny Sebastian ◽  
Mark Ranjan Jesudason
Keyword(s):  
Rectal Cancer ◽  
Intestinal Obstruction ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Number Of Patients ◽  
Disease Free

Background: The management of locally advanced rectal cancer is multi-modal. In India, a number of patients present with features of intestinal obstruction and are diverted prior to initiation of chemo-radiation therapy. The purpose of this paper is to study the demographics and oncological outcomes of obstructed locally advanced rectal cancer (OLARC) requiring pre-therapy diversion colostomy in comparison with patients who did not need pre-treatment diversion (non-obstructed group).Methods: This is a retrospective analysis of a prospective data-base. Patients diagnosed with non-metastatic locally advanced adenocarcinoma of the rectum in a colorectal unit of a tertiary care teaching hospital between August 2012 and December 2014 were analyzed. Data was collected from hospital records and telephonic interviews.Results: Two hundred and thirteen patients were diagnosed to have locally advanced rectal cancer.  One hundred and fifty patients (70.4%) did not have features of intestinal obstruction and received NACRT upfront and 63 (29.6%) required pre-therapy diversion colostomy. Thirty-nine patients (61.9%) completed therapy (neo-adjuvant chemo-radiotherapy followed by Surgery and adjuvant chemotherapy) in the obstructed group, compared to 127(84.7%) in the non-obstructed group (0<0.05) who completed all components of cancer directed therapy.  The 3-year overall survival (OS) of the obstructed and non-obstructed groups was 59% vs 90% (p<.001) and the disease-free survival (DFS) was 51% and 76% (p<0.01) respectively.Conclusions: In the era of multi-modal therapy, patients with obstructed locally advanced rectal cancer have worse oncological outcomes with respect to overall and disease-free survival.

scholarly journals The Survival after Laparoscopic Versus Open Curative Excision for Rectal Cancer

2020 ◽  
Vol 7 ◽  
Author(s):  
Turki Alshammari ◽  
Sulaiman Alshammari ◽  
Ali Alsaffar ◽  
Riyadh Hakami ◽  
Mohammed Alali ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Disease Free Survival ◽  
Research Centre ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Distal Recurrence ◽  
Disease Free

Background: Management of rectal cancer has been evolved over the past two decades with the introduction of total mesorectal excision (TME) and laparoscopic resection. Objective: This study aims to assess the difference in the long term outcomes after laparoscopic and open resection for potentially curable, non-metastatic rectal cancer patients.Methods: This is a retrospective study which has been conducted in a single tertiary care center where the patients were recruited from the colorectal database of the Section of Colon and Rectal Surgery at King Faisal Specialist Hospital & Research Centre (KFSH&RC). It included all the patients who had non-metastatic rectal cancer and underwent laparoscopic or open curative resection regardless of their age or the comorbid status during the period from January 2012 – December 2015. We studied the long-term outcomes for those patients which included the completeness of resection of the tumor, overall 3-year survival, 3-year disease free survival, local recurrence and distal recurrence of the cancer.Results:120 patients were included in this study, 69 of them were males and 51 were females. 86 (71.7%) of them underwent open surgery while 34 (28.3%) underwent laparoscopic surgery. After a mean follow up of 32.4 months: 104 patients were alive, 7 deceased and 9 were lost of follow up. Local recurrence in the open approach (OA), and laparoscopic approach (LA) groups was 3/86 (3.5%) and 4/34 (11.8%) respectively. Distal recurrence occurred in 12/86 (14%) of OA and 5/34 (14.7%) of LA. Overall 3-years survival for OA and LA was 89% and 97% respectively and the 3-years disease free survival was 49% and 57% respectively.Conclusion: Laparoscopic and open rectal excision were similar in their outcome.  

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