Comparison between robotic-assisted and laparoscopic sphincter-preserving operations for ultra-low rectal cancer: a single institutional retrospective study

Abstract Background Sphincter-preserving operations for ultra-low rectal cancer include low anterior resection and intersphincteric resection. In low anterior resection, the distal rectum is divided by a transabdominal approach, which is technically demanding. In intersphincteric resection, a perineal approach is performed. We aimed to evaluate whether robotic-assisted surgery is technically superior to laparoscopic surgery for ultra-low rectal cancer. The frequency of conducting low anterior resection by a specific procedure can indicate the technical superiority of that procedure for ultra-low rectal cancer. Thus, we compared the frequency of low anterior resection between robotic-assisted and laparoscopic surgery in cases of sphincter-preserving operations. Methods We investigated 183 patients who underwent sphincter-preserving robotic-assisted or laparoscopic surgery for ultra-low rectal cancer (lower border within 5 cm of the anal verge) between April 2010 and March 2020. The frequency of low anterior resection was compared between laparoscopic and robotic-assisted surgeries. The clinicopathological factors associated with an increase in performing low anterior resection were analyzed by multivariate analyses. Results Overall, 41 (22.4%) and 142 (77.6%) patients underwent laparoscopic and robotic-assisted surgery, respectively. Patient characteristics were similar between the groups. Low anterior resection was performed significantly more frequently in robotic-assisted surgery (67.6%) than in laparoscopic surgery (48.8%) (p = 0.04). Multivariate analyses showed that tumor distance from the anal verge (p < 0.01) and robotic-assisted surgery (p = 0.02) were significantly associated with an increase in the performance of low anterior resection. The rate of postoperative complications or pathological results was similar between the groups. Conclusions Compared with laparoscopic surgery, robotic-assisted surgery significantly increased the frequency of low anterior resection in sphincter-preserving operations for ultra-low rectal cancer. Robotic-assisted surgery has technical superiority over laparoscopic surgery for ultra-low rectal cancer treatment.

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Robotic-assisted surgery for low rectal cancer: Initial experiences from 15 consecutive cases at Cho Ray Hospital

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2019.4.4 ◽

2019 ◽

Vol 9 (4) ◽

Author(s):

Viet Trung Lam ◽

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Range Of Motion ◽

Laparoscopic Resection ◽

Low Rectal Cancer ◽

Safe Procedure ◽

Conventional Laparoscopic Surgery ◽

Robotic Assisted ◽

Conventional Laparoscopic ◽

Robotic Assisted Surgery

Abstract Introduction: Conventional laparoscopic surgery for low rectal cancer has several challenges regarding the technique issues such as a limited range of motion instruments. With the advantages, Robotic-assisted surgery has resolved this problems compared with the conventional laparoscopic surgery because it’s dexterity could improve the range of motion instruments. To evaluate the short-term and early oncological outcomes of robotic-assisted surgery for low rectal cancer. Material and Methods: Prospective study to describe one consecutive series of robotic-assisted laparoscopic resection for low rectal cancer at Department of Digestive Surgery of Cho Ray hospital. Results: Between October 2017 and June 2018, robotic-assisted laparoscopic resection with total mesorectal excision has performed on 15 consecutive patients with rectal cancer at Cho Ray hospital. The mean age was 50. Male/ female ratio was 2.75/1. The types of procedures performed were: 13 low anterior resections (LAR), 1 intersphincteric resection with coloanal anastomosis, and 1 abdominoperineal resection (APR). The overall mean operation time was 240 minutes. None of the cases was converted to open procedure. Mean harvested lymph nodes were 12. There was no surgical morbidity or mortality. On the postoperative day 1 and 2, mean visual analog scale (VAS) scores were 3.5. Mean postoperative hospital stay was 7.5 days. Conclusion: Robotic-assisted laparoscopic resection for low rectal cancer is a feasible and safe procedure with acceptable oncological results.

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A comparison of the long-term anorectal function between laparoscopic intersphincteric resection and low anterior resection for low rectal cancer

Surgery Today ◽

10.1007/s00595-018-1669-0 ◽

2018 ◽

Vol 48 (10) ◽

pp. 921-927 ◽

Cited By ~ 2

Author(s):

Kenji Kawada ◽

Koya Hida ◽

Suguru Hasegawa ◽

Yoshiharu Sakai

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Anorectal Function ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Laparoscopic Intersphincteric Resection

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OUTCOME OF SPHINCTER PRESERVING RECTAL RESECTION FOR LOW RECTAL CANCER

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.1.5 ◽

2017 ◽

pp. 36-40

Author(s):

Vinh Quy Truong ◽

Anh Vu Pham ◽

Quang Thuu Le

Keyword(s):

Rectal Cancer ◽

Functional Outcomes ◽

Low Anterior Resection ◽

Rectal Resection ◽

Anal Verge ◽

Low Rectal Cancer ◽

Central Hospital ◽

Mesorectal Excision ◽

Pull Through ◽

Stage T1

Purpose: To evaluate the functional outcome of sphincter-preserving rectal resection for low rectal cancer. Materials and Methods: From April 2009 to January 2016, there are 52 patients who underwent sphincter-preserving rectal resection with total mesorectal excision with low rectal cancer (<6cm from the anal verge) at Hue Central Hospital, Hue, Vietnam. Results: the average age 62.7 ± 12.8, the distance of tumor from anal verge include four group (≤ 3cm 1.9%; 3 to ≤ 4cm 17.3%; 4 to ≤ 5cm 34.6%; > 5 cm). T stage T1/ T2/T3: 1.9%/28.8%/69.2%. The following time is 33.8 ± 18.9 month. Overall recurrence was 13/18(27.1%), local recurrence was 5 (10.4%). Total survival was 40.5 ± 2.9 month. Technique: intersphincteric preservation 14 (26.9%), low anterior resection 17 (32.7%) and pull-through procedure 21 (40.4%). The distance of anatomosis from anal verge: from 1 to ≤ 2 cm:14 (26.9%); from 2 to ≤ 3cm: 21 (40.4%); from 3 to ≤ 4 cm: 17 (32.7%). Bowels movement of 3 month: 4.7 ± 3.2 and 12th month: 2.7 ± 1.6 (p< 0.01). Conclusions: Sphincterpreserving rectal resection using may provide a good continence and oncologic safety. The patients are acceptable with the results of functional outcomes. Key words: Low rectal cancer, sphincter-preserving

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Faculty Opinions recommendation of Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718323589.793523137 ◽

2016 ◽

Author(s):

Scott Steele

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Comparative Study ◽

Anterior Resection ◽

Low Anterior Resection ◽

Oncologic Outcomes

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The impact of timing of stoma closure on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer

Kurdistan Journal of Applied Research ◽

10.24017/science.2021.1.13 ◽

2021 ◽

pp. 126-134

Author(s):

Hemn Hussain Kaka Ali ◽

Qalandar Hussein Abdulkarim ◽

Karzan Seerwan ◽

Barham M. M .Salih

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Anal Verge ◽

Loop Ileostomy ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome ◽

Closure Of Ileostomy ◽

The Mean ◽

The Impact

This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus. A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.

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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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The role of intersphincteric resection and the ‘Anterior Perineal Plane for ultra-low Anterior Resection’ for rectal cancer

Colorectal Disease ◽

10.1111/j.1463-1318.2008.01530.x ◽

2008 ◽

Vol 10 (7) ◽

pp. 736-737 ◽

Cited By ~ 22

Author(s):

H. S. Tilney ◽

P. P. Tekkis

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Intersphincteric Resection

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Extended intersphincteric resection with quadrant resection of external sphincter after neoadjuvant mid-course chemoradiotherapy in the very low rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14181 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14181-e14181

Author(s):

Nahmgun Oh ◽

Sanghwa Ko ◽

Hyunsung Kim

Keyword(s):

Rectal Cancer ◽

Anal Verge ◽

External Sphincter ◽

Postoperative Mortality ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Pelvic Cavity ◽

Group I ◽

Very Low Rectal Cancer ◽

The Mean

e14181 Background: To evaluate the results of extended intersphincteric resection of T3 rectal cancer situated below 4cm from the anal verge, comparing the results of simple intersphincteric resection of T2 rectal cancer after mid-course chemoradiotherapy. Methods: Between 2000 Between 2000 and 2006, 67 patients with rectal cancer below 4cm from anal verge, underwent abdomino-intersphincteric resection reconstructed by inversion proctoplasty with a colonic J-pouch and diverting ileostomy. All patients received a total irradiation dose of 30 Gy with conventional fractions for 3 weeks. Capecitabine was administered 1000mg/m2 twice a day on 21 days during radiotherapy, followed curative surgery in a week without resting period. After preoperative radio-chemotherapy, patients with overt T2 lesion were 27 cases (40.3%) and received intersphincteric resection (Group I: simple intersphincteric resection), and patients with borderline cases or T3 lesion were 40 cases (59.7%) and received intersphincteric resection with quadrant resection of upper external sphincter and primary repair of the external sphincter as inversion proctoplasty (Group II: extended intersphincteric resection). Results: The mean patients age was 61.2 years. The mean location of cancer was at 3.2cm from anal verge (2-4cm). Anastomotic leakage was confirmed in 11 patients (16.4%). There was no postoperative mortality. The grade I, II of continence by Kirwan classification was 81.5%, 80.0% in Group I and II. Under 3 times stool frequency per day was 51.9%, 62.5% in Group I and II. Two patients (3.0%) experienced locoregional recurrence of pelvic cavity. 5-year overall survival rate was 83.6%. Conclusions: Simple and extended intersphincteric resection is seemed to be a safe and functionally acceptable procedure. And, neoadjuvant mid-course chemoradiotherapy using oral capecitabine 2,000 mg/m2/day on 21 days during 2 Gy radiation of each 15 weekdays is seemed to be a tolerable and effective modality, in patients with very low rectal cancer.

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