Evaluation of pilot experience with robotic-assisted proctectomy and coloanal anastomosis for rectal cancer

Abstract

Background: Robotic-assisted proctectomy with coloanal anastomosis (RPCA) is an innovative technique of pelvic dissection for low rectal cancer. Our objective was to evaluate our pilot experience with this procedure compared with open proctectomy with coloanal anastomosis (OPCA). Methods:We performed a retrospective 5-year review of all consecutive cases of RPCA and OPCA performed at our institute. We focused on tumour characteristics, quality of surgery, analgesic requirements, average length of hospital stay (LOS), complications and long-term outcomes.Results: Three patients underwent RPCA and 25 had OPCA. The average duration of surgery was similar (288 min for RPCA v. 285 min for OPCA). Four patients in the OPCA group had positive or very close margins, and 2 had a mesorectal defect less than 5 mm. The average LOS was 6.66 and 9.29 days in the RPCA and OPCA groups, respectively, and the average duration of epidural or patient-controlled anesthesia was 2.67 and 5.16 days, respectively. We did not perform a statistical comparison because of the discordant size and sex distribution between the groups. There were no perioperative complications in the RPCA group, and all patients had negative margins and adequate lymph node retrievals with no long-term complications or recurrence recorded so far. Conclusion:Our very early experience with RPCA is quite encouraging, suggesting that it is a safe alternative to OPCA with a similar duration and the added benefits of a minimally invasive procedure, including decreased LOS and reduced postoperative analgesic requirements.Contexte : La proctectomie robot-assistée avec anastomose colo-anale est une technique novatrice de dissection pelvienne pour les cancers du bas rectum. Notre objectif était d'évaluer notre expérience pilote avec cette intervention, comparativement à la proctectomie ouverte avec anastomose colo-anale.Méthodes : Nous avons procédé à une revue rétrospective sur 5 ans de tous les cas consécutifs de proctectomie robot-assistée et de proctectomie ouverte avec anastomose coloanale effectuées dans notre établissement. Nous nous sommes concentrés sur les caracté-ristiques des tumeurs, la qualité de l'intervention chirurgicale, les besoins analgésiques, la durée moyenne du séjour hospitalier (DSH), les complications et l'issue à long terme.

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity

“…[10][11][12][13][14][15][16][17][18][19] Prior studies have demonstrated that robotic surgery is feasible and safe 7,[11][12][13][14][15][16][17][18]20,21 but may be associated with higher cost and longer operative duration, particularly for rectal resections. 10,25 Given the single-centre reporting bias present in much of the literature, there is a need for research using multi-institutional data.…”

Robotic Total Mesorectal Excision for Low Rectal Cancer: A Narrative Review and Description of the Technique

“…The comparison of the pathological outcomes shows how robotic surgery provides high-quality mesorectal resection with a comparable rate of CRM negativity and mean DRM [12,13,[24][25][26][27][28][40][41][42][43][44]. Involvement of the circumferential resection margin is a wellestablished cause of local recurrence and worse long-term survival [45].…”