Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center

Hino, Hitoshi; Yamaguchi, Takashi; Kinugasa, Yusuke; Shiomi, Akio; Kagawa, Hiroyasu; Yamakawa, Yushi; Numata, Masakatsu; Furutani, Akira; Yamaoka, Yusuke; Manabe, Shoichi; Suzuki, Takuya; Kato, Shunichiro

doi:10.1007/s10151-017-1710-0

Cited by 26 publications

(11 citation statements)

References 35 publications

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“…The group without preoperative CRT was given CRT after surgery. At our institution, CRT was applied for patients with locally advanced rectal cancers for the purpose of obtaining clear resected margins after surgery and maximizing the chance of preserving anal sphincters and preventing urinary diversion [ 17 ]. The characteristics of both rectal cancer patient groups are shown in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

Effect of preoperative chemoradiotherapy on the immunological status of rectal cancer patients

Yasui

Kondou

Iizuka

et al. 2020

Journal of Radiation Research

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The aim of the study was to investigate the effect of chemo-radiation on the genetic and immunological status of rectal cancer patients who were treated with preoperative chemoradiotherapy (CRT). The expression of immune response-associated genes was compared between rectal cancer patients treated (n = 9) and not-treated (n = 10) with preoperative CRT using volcano plot analysis. Apoptosis and epithelial-to-mesenchymal transition (EMT) marker genes were analysed by quantitative PCR (qPCR). Other markers associated with the tumor microenvironment (TME), such as tumor-infiltrating lymphocytes (TIL) and immune checkpoint molecules, were investigated using immunohistochemistry (IHC). The clinical responses of preoperative CRT for 9 rectal cancer patients were all rated as stable disease, while the pathological tumor regression score (TRG) revealed 6 cases of grade2 and 3 cases of grade1. According to the genetic signature of colon cancers, treated tumors belonged to consensus molecular subtype (CMS)4, while not-treated tumors had signatures of CMS2 or 3. CRT-treated tumors showed significant upregulation of EMT-associated genes, such as CDH2, TGF-beta and FGF, and cancer stem cell-associated genes. Additionally, qPCR and IHC demonstrated a suppressive immunological status derived from the upregulation of inflammatory cytokines (IL-6, IL-10 and TGF-beta) and immune checkpoint genes (B7-H3 and B7-H5) and from M2-type macrophage accumulation in the tumor. The induction of EMT and immune-suppressive status in the tumor after strong CRT treatment urges the development of a novel combined therapy that restores immune-suppression and inhibits EMT, ultimately leading to distant metastasis control.

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Section: Methodsmentioning

confidence: 99%

Effect of preoperative chemoradiotherapy on the immunological status of rectal cancer patients

Yasui

Kondou

Iizuka

et al. 2020

Journal of Radiation Research

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“…Dissection beyond the TME plane and multivisceral resection for rectal cancer are also technically challenging extended procedures. Only two studies to date have addressed this procedure as performed by RALS . Both Hino et al.…”

Section: Extended Proceduresmentioning

confidence: 99%

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Matsuyama

Kinugasa

Nakajima

et al. 2018

Annals of Gastroent Surgery

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Interest in minimally invasive surgery has increased in recent decades. Robotic‐assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual‐console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.

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“…Notwithstanding the potential benefits of synchronous resections and the rising popularity of robotic surgery, 12 reports on multivisceral robotic procedures remain limited 13–16 . This has been partly due to the limitations of the older surgical robots, which were designed to operate within a confined surgical field 17 .…”

Section: Discussionmentioning

confidence: 99%

Technical insights to multivisceral resections using the da Vinci Xi

Ngu

Shannon

et al. 2022

ANZ Journal of Surgery

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Background There have been few reports on the feasibility and safety of robotic multivisceral surgeries. The da Vinci Xi boasts significant upgrades that improve its applicability in combined resections. We report our early experience of multivisceral, multi‐quadrant resections with the Xi system. Methods Between May 2015 and August 2019, 13 multivisceral resections were performed. Patient demographics, procedural data, and perioperative outcomes were evaluated. Results The procedures were completed at a median operative time of 290 (range, 210–535) minutes. The median postoperative length of hospital stay was 3.5 (range, 2–7) days. There was one case of readmission for anastomotic leak, but no positioning injuries, external robot arm collisions or issues arising from trocar position. There were no cases of perioperative mortality. Conclusion Multivisceral resections can be safely accomplished using the Xi. Further studies are necessary to ascertain whether there are benefits of the robotic approach over conventional laparoscopy in these complex cases.

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Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center

Abstract: Robotic-assisted multivisceral resection for rectal cancer is safe and technically feasible.

Cited by 26 publications

References 35 publications

Effect of preoperative chemoradiotherapy on the immunological status of rectal cancer patients

Effect of preoperative chemoradiotherapy on the immunological status of rectal cancer patients

Robotic‐assisted surgery for rectal cancer: Current state and future perspective

Technical insights to multivisceral resections using the da Vinci Xi

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