Oncological Outcomes of Robotic-Assisted Surgery With High Dissection and Selective Ligation Technique for Sigmoid Colon and Rectal Cancer

Abstract

Background: Curative resection of sigmoid colon and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the complication rate. We present preliminary experiences of operative and oncologic outcomes of patients with rectal or sigmoid colon cancer who underwent robotic surgery employing the high dissection and selective ligation technique. Methods: Over May 2013 to April 2017, 113 stage I-III rectal or sigmoid colon cancer patients underwent robotic surgery with the single-docking technique at one institution. We performed D3 lymph node dissection and low-tie ligation of the IMA (i.e., high dissection and selective ligation technique). Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Results: Sphincter preservation rate was 96.3% in rectal cancer patients. Median number of harvested lymph nodes was 12. Apical nodes were pathologically harvested in 84 (82.4%) patients. R0 resection was performed in 108 (95.6%) patients. Overall complication rate was 17.7%; but most complications were mild and the patients recovered uneventfully. Estimated 5-year OS was 86.1% and 3-year DFS was 79.6% after median follow-up periods of 49.1 months (range, 5.3-85.3). Yin et al. High Dissection and Selective Ligation Conclusions: High dissection of the IMA and selective ligation of the major feeding vessel to the sigmoid colon or rectum can be safely performed using da Vinci Surgical System,yielding favorable clinical, and oncologic outcomes in rectal or sigmoid colon cancer treatment.

Exploring Central Vascular Anatomy With Axial Computed Tomography During Surgery for Sigmoid Colon and Rectal Cancer: New Insights Into the Anatomical Relationship Between the Inferior Mesenteric Artery and the Duodenum

“…Main lymph node metastasis has been reported to occur in approximately 1.7-13.5% of sigmoid colon and rectal cancers (6)(7)(8). Despite this relatively low incidence, D3 dissection has been shown to convey a significant survival advantage in pT3 and pT4 colorectal cancer patients (9,10). Additionally, D3 dissection can be safely performed with preservation of the LCA ("low tie") and autonomic nerves via a laparoscopic approach (11,12).…”

Characterization of endoplasmic reticulum stress unveils ZNF703 as a promising target for colorectal cancer immunotherapy

“…Colorectal cancer (CRC) is one of the most common malignant tumors globally, ranking third and second in incidence and mortality, respectively [ 1 ]. Although present therapeutic strategies such as surgery [ 2 ], radiotherapy [ 3 ], chemotherapy [ 4 ], and immunotherapy [ 5 ] have greatly improved the prognosis of patients with CRC. There is still a proportion of patients who are insensitive to these treatment regimens, become resistance at the later period of treatment, and even relapse after tumor clearance.…”

Clinical Safety and Effectiveness of Robotic-Assisted Surgery in Patients with Rectal Cancer: Real-World Experience over 8 Years of Multiple Institutions with High-Volume Robotic-Assisted Surgery

“…Compared with open surgical and conventional laparoscopic approaches for patients with rectal cancers, robotic-assisted rectal surgery (RRS) appears to be favorable in terms of perioperative and short-term oncological outcomes [ 10 , 11 , 12 , 13 , 14 , 15 ]. Studies on RRS in Taiwan have demonstrated that RRS is safe and feasible for high dissection and low or selective ligation of the inferior mesentery artery, for the single-docking technique, in cases of long intervals between the completion of radiotherapy and robotic-assisted surgery, and for older adult patients aged >70 years [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, these studies have been conducted in a single institution and have had small sample sizes.…”