Robotic surgery for clinical T4 rectal cancer: short- and long-term outcomes

Yamaoka, Yusuke; Shiomi, Akio; Kagawa, Hiroyasu; Hino, Hitoshi; Manabe, Shoichi; Kato, Shunichiro; Hanaoka, Marie

doi:10.1007/s00464-020-08241-9

Cited by 16 publications

(12 citation statements)

References 29 publications

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“…Similar findings in multiple small retrospective review of all T4 tumours, where multivisceral resections and exenterations constituted a minority, were observed 30 . In a recent report of robotic resections for cT4 rectal cancers, 52 patients had cT4b disease and 3-year LR was 4 per cent and disease-free survival 70.4 per cent 31 .…”

Section: Discussionmentioning

confidence: 98%

Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes

et al. 2021

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Background This study compared the surgical and oncological outcomes of open and minimally invasive pelvic exenteration. Methods Patients who underwent pelvic exenterations for primary locally advanced rectal cancers with invasion of the urogenital organs (central and anterior disease) between August 2013 and September 2020 were reviewed retrospectively. Patients were categorized as undergoing open or minimally invasive surgery (MIS) and these groups were compared for perioperative outcomes and 3-year survival (overall, recurrence-free and local relapse-free survival). Multivariable Cox regression analysis was performed to assess the independent influence of approach of surgery and cancer features on recurrence-free survival (RFS). Results Of the 158 patients who underwent pelvic exenteration, 97 (61.4 per cent) had open exenterations and 61 (38.6 per cent) patients had an MIS resection (44 patients (72 per cent) using laparoscopy and 17 (28 per cent) using robotic surgery). There were 96 (60.8 per cent) total pelvic exenterations and 62 (39.2 per cent) posterior pelvic exenterations. MIS exenterations had significantly longer operative times (MIS versus open: 640 mins versus 450 mins; P < 0.001) but reduced blood loss (MIS versus open: 900 ml versus 1600 ml; P < 0.001) and abdominal wound infections (MIS versus open: 8.2 versus 17.5 per cent; P = 0.020) without a difference in hospital stay (MIS versus open: 11 versus 12 days; P = 0.620). R0 resection rates and involvement of circumferential resection margins were similar (MIS versus open: 88.5 versus 91.8 per cent, P = 0.490 and 13.1 versus 8.2 per cent, P = 0.342 respectively). At a median follow-up of 29 months, there were no differences in 3-year overall survival (MIS versus open: 79.4 versus 60.2 per cent; P = 0.251), RFS (MIS versus open: 51.9 versus 47.8 per cent; P = 0.922) or local relapse-free survival (MIS versus open: 89.7 versus 75.2 per cent; P = 0.491. On multivariable analysis, approach to surgery had no bearing on RFS, and only known distant metastasis, aggressive histology and inadequate response to neoadjuvant radiation (pathological tumour regression grade greater than 3) predicted worse RFS. Conclusion MIS exenterations documented longer procedures but resulted in less blood loss and fewer wound infections compared with open surgeries. In the setting of an experienced centre, the hospital stay, R0 resection rates and oncological outcomes at 3 years were similar to those of open exenterations.

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Section: Discussionmentioning

confidence: 98%

Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes

et al. 2021

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“…For preoperative intestinal stenosis, the amount of sodium picosulfate taken was reduced to 5 ml 2 days before and the day before surgery. The surgical procedures for Ro-LAR at our institution have been described previously [11,12]. At the time of anastomosis, intestinal tract cleansing (1000 ml of isodine solution diluted with saline) was performed before rectal transection.…”

Section: Ro-lar Anastomosis Protocolmentioning

confidence: 99%

Use of a Powered Circular Stapler Can Prevent Anastomotic Air Leakage in Robotic Low Anterior Resection for Rectal Cancer

Nanishi

Hino

Shiomi

et al. 2023

J Anus Rectum Colon

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Objectives: Preventing anastomotic complications during rectal cancer surgery is important. Compared with a manual circular stapler, a powered circular stapler is expected to reduce undesirable tension during anastomosis. However, whether a powered circular stapler can reduce anastomotic complications during robotic low anterior resection (Ro-LAR) remains unclear. We aimed to investigate whether the use of a powered circular stapler contributes to safe anastomosis in Ro-LAR. Methods: A total of 271 patients who underwent Ro-LAR for rectal cancer between April 2019 and April 2022 were included. Depending on the type of device employed, patients were divided into a powered circular stapler group (PCSG) and a manual circular stapler group (MCSG). Clinicopathological features and surgical outcomes were compared between the two groups. Results: There were no differences in clinicopathological characteristics and surgical outcomes, except for anastomotic outcomes, between the two groups. Patients with positive air leak tests were significantly more in the MCSG ( p =0.026; PCSG, 1.5%; MCSG, 8.0%). Frequencies of anastomotic leakage ( p =0.486; PCSG, 6.1%; MCSG, 8.9%) and anastomotic bleeding ( p =1.000; PCSG, 0.7%; MCSG, 0.8%) were similar between the two groups. Multivariate analysis showed that the use of a powered circular stapler significantly increased the negative leak tests ( p =0.020, odds ratio 6.74, 95% confidence interval 1.35-33.56). Conclusions: Use of a powered circular stapler in Ro-LAR for rectal cancer was significantly associated with a negative air leak test, suggesting that it contributes to stable and safe anastomosis.

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“…Anastomotic leakage was clinically diagnosed as the presence of an intra-abdominal collection adjacent to the anastomosis upon CT or via a radiographic enema with hydrosoluble contrast. Residual urine volume was measured after removal of the urethral catheter on postoperative day 5; a residual urine volume of ≥50 mL was regarded as urinary retention [17,19,20]. These patients performed self-catheterization until the residual urine volume was <50 mL.…”

Section: Study Design and Patientsmentioning

confidence: 99%

“…Rectal cancers were staged using the tumour/node/metastasis (TNM) classification [16]. Neoadjuvant CRT was performed in patients for whom R0 might be difficult to achieve without CRT or for whom shrinkage of the tumour that invaded adjacent organs, such as the prostate and bladder trigone, via CRT might enable anal preservation or avoid urinary diversion [17]. Use of nCRT involved the administration of capecitabine and radiation therapy in 25 initial fractions (45 Gy) to a large pelvic field, and the addition of three final fractions (5.4 Gy) as a boost.…”

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confidence: 99%

Risk factors for and longitudinal course of male sexual dysfunction after robotic rectal cancer surgery

et al. 2023

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Aim The aim of this work was to investigate the risk factors associated with the incidence of sexual dysfunction in patients who underwent robot‐assisted surgery with several treatment options, such as neoadjuvant chemoradiotherapy and lateral lymph node dissection, and clarify the longitudinal course of erectile function in risk groups. Method A total of 203 male patients who underwent robot‐assisted total mesorectal excision for rectal cancer between 2013 and 2019 were included. The risk factors for erectile and ejaculatory dysfunction as well as the longitudinal course of erectile function were retrospectively investigated in all cohorts and several risk groups, including those who underwent neoadjuvant chemoradiotherapy, lateral lymph node dissection and adjuvant chemotherapy. Erectile dysfunction was assessed using the International Index of Erectile Function and ejaculatory dysfunction was assessed using original questions. The survey was performed preoperatively and at 3, 6 and 12 months postoperatively. Results Erectile and ejaculatory dysfunction occurred in 46.8% and 15.7% of the patients, respectively. Multivariate analysis showed that neoadjuvant chemoradiotherapy was an independent risk factor for erectile dysfunction. Erectile function recovered longitudinally to the preoperative level overall, as well as in lateral lymph node dissection and postoperative adjuvant chemotherapy subgroups; however, recovery was poor in the neoadjuvant chemoradiotherapy group, even at 12 months postoperatively. Conclusion Neoadjuvant chemoradiotherapy was found to be a risk factor for erectile dysfunction after robot‐assisted surgery for rectal cancer. Erectile function recovered postoperatively in patients undergoing lateral lymph node dissection; however, those receiving neoadjuvant chemoradiotherapy showed poor recovery, even at 12 months postoperatively.

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Robotic surgery for clinical T4 rectal cancer: short- and long-term outcomes

Cited by 16 publications

References 29 publications

Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes

Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes

Use of a Powered Circular Stapler Can Prevent Anastomotic Air Leakage in Robotic Low Anterior Resection for Rectal Cancer

Risk factors for and longitudinal course of male sexual dysfunction after robotic rectal cancer surgery

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