Functional outcomes after robotic or laparoscopic intersphincteric resection – An inverse probability weighting analysis

Kazi, Mufaddal; Jajoo, Bhushan; Rohila, Jitender; Dohale, Sayali; Bhuta, Prajesh; Desouza, Ashwin; Saklani, Avanish

doi:10.1016/j.ejso.2022.07.009

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…Importantly, the laparoscopic group in our study was not a historic cohort, as evidenced by the similar follow-up duration in both arms, and thus the influence of variable learning curves is eliminated. Moreover, improvements in bowel function or global quality of life have never been demonstrated for robotic surgery [20,21]. As in most cases, 'it is rarely the tool, rather it's the person wielding it and how it is used'.…”

Section: Discussionmentioning

confidence: 99%

Comparing robotic with laparoscopic beyond total mesorectal excision for advanced rectal cancer—a propensity‐matched analysis

Kazi,

Rastogi,

Raj

et al. 2024

Colorectal Disease

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AimRobotic surgery is increasingly being used for rectal resection, with short‐term benefits such as reduced hospital stay, faster bowel recovery and fewer complications. However, its utility for advanced rectal cancers requiring beyond total mesorectal excision has not been adequately evaluated. The aim of this study was to compare robotic and laparoscopic approaches for extended rectal resection, with postoperative and short‐term oncological outcomes as endpoints.MethodA retrospective, single‐centre study of patients with advanced rectal cancer requiring extended rectal resection between January 2017 and December 2022 was carried out. Beyond total mesorectal excisions included pelvic exenteration, en bloc soft tissue or partial organ resection with the rectum, and lateral pelvic node dissection. Propensity score matching in a 4:1 ratio of laparoscopic to robotic was performed with age, sex, comorbidities, body mass index, organs involved, clinical T stage and colonoscopic obstruction.ResultsA total of 425 beyond total mesorectal excisions were performed by minimally invasive approaches during the study period, and after propensity matching 228 laparoscopic operations were compared with 57 robotic resections. All baseline characteristics were balanced. No difference in blood loss, postoperative complications, length of hospital stay, positive resection margin or nodal yield was found, but there was a somewhat longer operating duration in robotics. The 2‐year disease‐free and overall survival were also similar.ConclusionsNo differences in postoperative or short‐term oncological outcomes were found between robotic and laparoscopic beyond total mesorectal excisions for advanced tumours when performed by teams experienced in both robotics and laparoscopy.

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Section: Discussionmentioning

confidence: 99%

Comparing robotic with laparoscopic beyond total mesorectal excision for advanced rectal cancer—a propensity‐matched analysis

Kazi,

Rastogi,

Raj

et al. 2024

Colorectal Disease

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“…This, along with the hand‐sewn CAA, may cause functional impairment [49, 50], including faecal, urinary continence and sexual function. The literature concentrates mainly on anorectal function showing functional results with different scoring systems or institutional questionnaires [39, 41, 51–54] making comparison of outcomes difficult. Therefore, the panel saw a need to standardize functional outcome.…”

Section: Discussionmentioning

confidence: 99%

International standardization and optimization group for intersphincteric resection (ISOG‐ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome

Piozzi

Khobragade

Aliyev³

et al. 2023

Colorectal Disease

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AimIntersphincteric resection (ISR) is an oncologically complex operation for very low‐lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future.MethodA modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra‐low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol.ResultsThree rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements.ConclusionThis study provides an international expert consensus‐based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.

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“…The results may not be generalizable to different demographics since age, sex, body mass index and preoperative bowel function all impact on postoperative functions. In populations where the incidence of preoperative and postoperative functional impairments are more severe than ours[1,16], there exists the possibility of different results. Finally, the role of anorectal ultrasound and dynamic defaecography can also be explored in the prediction of bowel function.…”

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confidence: 99%

Should anorectal manometry be routine before stoma reversal in patients after an intersphincteric resection?

et al. 2023

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IntroductionAnorectal manometry (ARM) is sometimes performed before ostomy reversal in patients with an intersphincteric resection (ISR) to predict bowel function. However, no clinical predictive data exist regarding its utility.MethodsThe single‐centre, retrospective data of ISR patients who had an ARM prior to ostomy reversal, and bowel functional assessment with the low anterior resection syndrome (LARS) and Wexner incontinence scores at least 6 months after reversal, were considered. Correlation statistics were performed with each of the manometric parameters and functional outcome categories.ResultsEighty‐nine patients were included. The median basal and squeeze pressures were 41 and 100 mmHg, respectively. Any LARS (score ≥20) and major incontinence (score ≥11) was observed in 51.7% and 16.9%, respectively. None of the manometric parameters (median basal or maximum squeeze pressure, anal canal length, volume at urge and the ability to expel) correlated with LARS or incontinence.ConclusionsAnorectal manometry (ARM) before ostomy reversal to predict bowel function at 6 months or beyond was not helpful in patients with an ISR and diverting stoma. No manometric parameter correlated with the LARS or Wexner incontinence scores.

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Functional outcomes after robotic or laparoscopic intersphincteric resection – An inverse probability weighting analysis

Cited by 7 publications

References 17 publications

Comparing robotic with laparoscopic beyond total mesorectal excision for advanced rectal cancer—a propensity‐matched analysis

Comparing robotic with laparoscopic beyond total mesorectal excision for advanced rectal cancer—a propensity‐matched analysis

International standardization and optimization group for intersphincteric resection (ISOG‐ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome

Should anorectal manometry be routine before stoma reversal in patients after an intersphincteric resection?

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