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Khan JS, Piozzi GN, Rouanet P, Saklani A, Ozben V, Neary P, Coyne P, Kim SH, Garcia-Aguilar J. Robotic beyond total mesorectal excision for locally advanced rectal cancers: Perioperative and oncological outcomes from a multicentre case series. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108308. [PMID: 38583214 DOI: 10.1016/j.ejso.2024.108308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Around 20% of rectal tumors are locally advanced with invasion into adjacent structures at presentation. These may require surgical resections beyond boundaries of total mesorectal excision (bTME) for radicality. Robotic bTME is under investigation. This study reports perioperative and oncological outcomes of robotic bTME for locally advanced rectal cancers. MATERIALS AND METHODS A multicentre, retrospective analysis of prospectively collected robotic bTME resections (July 2015-November 2020). Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated. RESULTS One-hundred-sixty-eight patients (eight centres) were included. Median age and BMI were 60.0 (50.0-68.7) years and 24.0 (24.4-27.7) kg/m2. Female sex was prevalent (n = 95, 56.8%). Fifty patients (29.6%) were ASA III-IV. Neoadjuvant chemoradiotherapy was given to 125 (74.4%) patients. Median operative time was 314.0 (260.0-450.0) minutes. Median estimated blood loss was 150.0 (27.5-500.0) ml. Conversion to laparotomy was seen in 4.8%. Postoperative complications occurred in 77 (45.8%) patients; 27.3% and 3.9% were Clavien-Dindo III and IV, respectively. Thirty-day mortality was 1.2% (n = 2). R0 rate was 92.9%. Adjuvant chemotherapy was offered to 72 (42.9%) patients. Median follow-up was 34.0 (10.0-65.7) months. Distant and local recurrences were seen in 35 (20.8%) and 15 patients (8.9%), respectively. Overall survival (OS) at 1, 3, and 5-years was 91.7, 82.1, and 76.8%. Disease-free survival (DFS) at 1, 3, and 5-years was 84.0, 74.5, and 69.2%. CONCLUSION Robotic bTME is technically safe with relatively low conversion rate, good OS, and acceptable DFS in the hands of experienced surgeons in high volume centres. In selected cases robotic approach allows for high R0 rates during bTME.
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Affiliation(s)
- Jim S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; University of Portsmouth, Portsmouth, UK.
| | | | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France.
| | - Avanish Saklani
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Acibadem Atakent Hospital, Istanbul, Turkey.
| | - Paul Neary
- Division of Colorectal Surgery, The Adelaide and Meath Hospital Ireland, Dublin, Ireland.
| | - Peter Coyne
- Department of Colorectal Surgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
| | - Seon Hahn Kim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
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Thorgersen EB, Solbakken AM, Strøm TK, Goscinski M, Spasojevic M, Larsen SG, Flatmark K. Short-term results after robot-assisted surgery for primary rectal cancers requiring beyond total mesorectal excision in multiple compartments. Scand J Surg 2024; 113:3-12. [PMID: 37787437 DOI: 10.1177/14574969231200654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
AIM Rectal cancers requiring beyond total mesorectal excision (bTME) are traditionally operated using an open approach, but the use of minimally invasive robot-assisted procedures is increasing. Introduction of minimal invasive surgery for complex cancer cases could be associated with compromised surgical margins or increased complication rates. Therefore, reporting results both clinical and oncological in large series is important. Since bTME procedure reports are heterogeneous, comparing results is often difficult. In this study, a magnetic resonance imaging (MRI) classification system was used to describe the bTME surgery according to pelvic compartments. METHODS Consecutive patients with primary rectal cancer operated with laparoscopic robot-assisted bTME were prospectively included for 2 years. All patients had tumors that threatened the mesorectal fascia, invaded adjacent organs, and/or involved metastatic pelvic lateral lymph nodes. Short-term clinical outcomes and oncological specimen quality were registered. Surgery was classified according to pelvic compartments resected. RESULTS Clear resection margins (R0 resection) were achieved in 95 out of 105 patients (90.5%). About 26% had Accordion Severity Grading System of Surgical Complications grade 3-4 complications and 15% required re-operations. About 7% were converted to open surgery. The number of compartments resected ranged from one to the maximum seven, with 83% having two or three compartments resected. All 10 R1 resections occurred in the lateral and posterior compartments. CONCLUSIONS The short-term clinical outcomes and oncological specimen quality after robot-assisted bTME surgery were comparable to previously published open bTME surgery. The description of surgical procedures using the Royal Marsden MRI compartment classification was feasible.
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Affiliation(s)
- Ebbe B Thorgersen
- Department of Gastroenterological Surgery Oslo University Hospital The Radium Hospital Pb 4950 Nydalen 0424 Oslo Norway
| | - Arne M Solbakken
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Tumor Biology, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Tuva K Strøm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mariusz Goscinski
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Milan Spasojevic
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Stein G Larsen
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Kjersti Flatmark
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Tumor Biology, Oslo University Hospital, The Radium Hospital, Oslo, Norway
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Gomez Ruiz M, Ballestero Diego R, Tejedor P, Cagigas Fernandez C, Cristobal Poch L, Suarez Pazos N, Castillo Diego J. Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality. Updates Surg 2023; 75:589-597. [PMID: 36763301 DOI: 10.1007/s13304-023-01450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
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Affiliation(s)
- Marcos Gomez Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Roberto Ballestero Diego
- Urology, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Patricia Tejedor
- Colorectal Surgery Unit, General Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Carmen Cagigas Fernandez
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Lidia Cristobal Poch
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Natalia Suarez Pazos
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Julio Castillo Diego
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
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Osseis M, Dahboul H, Mouawad C, Aoun R, Kassar S, Chakhtoura G, Noun R. Laparoscopic and robotic multivisceral resection in colorectal cancer: A case series and systematic review. Asian J Endosc Surg 2023. [PMID: 36599163 DOI: 10.1111/ases.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Multivisceral resection (MVR) with open approach is the standard surgical treatment for locally advanced colorectal cancer. However, the medical literature concerning the practice of minimally invasive MVR in order to reduce postoperative complications and hospital stay has been growing exponentially over the last years. The present study aimed to examine our experience and to provide a systematic review about the results and complications of minimally invasive MVR. METHODS Data of patients that underwent minimally invasive MVR for locally advanced colorectal cancer from 2015 to 2021 were retrospectively reviewed. The literature was searched for studies concerning minimally invasive MVR for colorectal cancer. RESULTS A total of 39 laparoscopic MVR were performed in our department. Complications occurred in 14 patients (35.9%) with major complications in five patients (18.82%) according to Clavien-Dindo classification. Conversion was required in one case (2.56%) with subsequent mortality (2.56%). Pathologic adjacent organs or structures invasion was observed in 30 patients (76.9%) and positive resection margin occurred in two cases (5.2%). Twenty-two studies including 1055 patients were identified after literature search. In these studies, laparoscopic surgery and robotic surgery were performed in 90.15% and 9.85% of the patients, respectively. R0 resection was established in 95% of cases, conversion rate varied between 0% and 41.7%, and postoperative mortality ranged between 0% and 7.7% in the included articles. CONCLUSION Minimally invasive approach may be a safe option for patients requiring MVR for locally advanced colorectal cancer, with equivalent oncological results and could result in better early postoperative outcomes to open approach. However, further studies on this topic are needed to confirm the results of the current study.
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Affiliation(s)
- Michael Osseis
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Christian Mouawad
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Rany Aoun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
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Ngu JCY, Shannon NB, Eu EW, Lee LS, Tan SS, Lim SKT, Ng FC, Chiow AKH. Technical insights to multivisceral resections using the da Vinci Xi. ANZ J Surg 2023; 93:166-172. [PMID: 36129451 DOI: 10.1111/ans.18064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
| | | | | | - Lip Seng Lee
- Department of General Surgery, Changi General Hospital, Singapore
| | - Siong San Tan
- Department of General Surgery, Changi General Hospital, Singapore
| | | | - Foo Cheong Ng
- Department of Urology, Changi General Hospital, Singapore
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Chen P, Zhou H, Chen C, Qian X, Yang L, Zhou Z. Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies. Front Surg 2022; 9:1006717. [DOI: 10.3389/fsurg.2022.1006717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTo evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.MethodsThree authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.ResultsThis meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.ConclusionsLaparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.
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Fahy MR, Hayes C, Kelly ME, Winter DC. Updated systematic review of the approach to pelvic exenteration for locally advanced primary rectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2284-2291. [PMID: 35031157 DOI: 10.1016/j.ejso.2021.12.471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/23/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To review the evidence regarding surgical advances in the management of primary locally advanced rectal cancer. BACKGROUND The management of rectal cancer has evolved significantly in recent decades, with improved (neo)adjuvant treatment strategies and enhanced perioperative protocols. Centralization of care for complex, advanced cases has enabled surgeons in these units to undertake more ambitious surgical procedures. METHODS A Pubmed, Ovid, Embase and Cochrane database search was conducted according to the predetermined search strategy. The review protocol was prospectively registered with PROSPERO (CRD42021245582). RESULTS 14 studies were identified which reported on the outcomes of 3,188 patients who underwent pelvic exenteration (PE) for primary rectal cancer. 50% of patients had neoadjuvant radiotherapy. 24.2% underwent flap reconstruction, 9.4% required a bony resection and 34 patients underwent a major vascular excision. 73.9% achieved R0 resection, with 33.1% experiencing a major complication. Median length of hospital stay ranged from 13 to 19 days. 1.6% of patients died within 30 days of their operation. Five-year overall survival (OS) rates ranged 29%-78%. LIMITATIONS The studies included in our review were mostly single-centre observational studies published prior to the introduction of modern neoadjuvant treatment regimens. It was not possible to perform a meta-analysis on the basis that most were non-randomized, non-comparative studies. CONCLUSIONS Pelvic exenteration offers patients with locally advanced rectal cancer the chance of long-term survival with acceptable levels of morbidity. Increased experience facilitates more radical procedures, with the introduction of new platforms and/or reconstructive options.
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Affiliation(s)
- Matthew R Fahy
- Centre for Graduate Research, University College Dublin, Belfield, Dublin, 4, Ireland; Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
| | - Cathal Hayes
- Centre for Graduate Research, University College Dublin, Belfield, Dublin, 4, Ireland; Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Michael E Kelly
- Centre for Graduate Research, University College Dublin, Belfield, Dublin, 4, Ireland; Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
| | - Desmond C Winter
- Centre for Graduate Research, University College Dublin, Belfield, Dublin, 4, Ireland; Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
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Kamel MK, Al-Qudah G, Shchatsko A, Keane CA, Serpa E, Nituica C, Blebea J, Marar O. Robotic Approach is Associated With a Lower Conversion Rate Compared to Laparoscopic Approach for Patients Undergoing Colectomy for T4b Colon Cancer. An Analysis of the National Cancer Database. Surg Innov 2022:15533506221125323. [PMID: 36069752 DOI: 10.1177/15533506221125323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the perioperative outcomes of patients undergoing open, laparoscopic, or robotic colectomy for T4b colon cancer, as well as the clinical factors associated with conversion to an open approach and its consequences on perioperative and oncologic outcomes. METHODS The National Cancer Database was queried for patients undergoing colectomy for cT4b colon cancer (2010-2016). Patients undergoing laparoscopic or robotic colectomy were matched using Propensity-Score analysis. Factors associated with conversion to an open approach were assessed using Logistic-regression multivariable-analysis (MVA). RESULTS Colectomy for cT4b colon cancer was performed in 9030 patients (open: n = 6,543, robotic: n = 157, laparoscopic: n = 2330). In the propensity-matched groups, robotic approach had lower rate of conversion (12% vs 37%, P < .001), shorter hospital stays (5 vs 7-days, P = .02), and similar overall-survival (5-yr: 49% vs 39%, P = .16), compared to laparoscopic approach. Conversion to an open approach was noted in 801(32%) of the patients undergoing minimally invasive surgical colectomy (robotic n = 23(15%), laparoscopic n = 778(33%). Factors associated with lower rate of conversion on multivariable-analysis included recent year of surgery (95% CI: 0.88-.97), robotic approach (95% CI: 0.22-.56), and surgeries performed in Academic hospitals (95% CI: 0.65-.96). Conversion to an open approach was associated with higher rate of positive parenchymal margin (31% vs 25%, P = .001), higher rate of 30-day readmission (12% vs 9.5%, P = .04), and similar overall survival (5-yr: 32% vs 35%, P = .19), compared to those who had no conversion. CONCLUSION At the National level, patients undergoing colectomy for T4b colon cancer via a robotic approach had more favorable perioperative outcomes compared to laparoscopic approach. Conversion to an open approach did not compromise long term survival, despite being associated with higher rate of positive margins and readmissions rate.
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Affiliation(s)
- Mohamed K Kamel
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Ghaith Al-Qudah
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Anastasiya Shchatsko
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Charles A Keane
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Eduardo Serpa
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Cristina Nituica
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - John Blebea
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Omar Marar
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
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Takahashi H, Maeda A, Harata S, Watanabe K, Yanagita T, Suzuki T, Ushigome H, Maeda Y, Shiga K, Ogawa R, Matsuo Y, Takiguchi S. Robot-assisted laparoscopic abdominoperineal resection with en bloc prostatectomy using the Retzius-sparing robot-assisted radical prostatectomy technique. Asian J Endosc Surg 2022; 15:688-692. [PMID: 35297181 DOI: 10.1111/ases.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The best surgical technique for rectal cancer invading the prostate remains controversial. Rectal resection with en bloc prostatectomy using a standard retropubic approach is an option but has disadvantages. We report a new surgical procedure applying Retzius-sparing robot-assisted radical prostatectomy. MATERIALS AND SURGICAL TECHNIQUE First, the rectum was mobilized mainly at its dorsal side. Next, the prostate was separated from the bladder and urethra via the pouch of Douglas approach without opening the Retzius cavity, after which the surgical specimen was extracted through the perineal wound. Lateral pelvic lymph node dissection was performed after vesicourethral anastomosis. DISCUSSION This new robotic procedure minimizes surgical trauma and preserves normal pelvic anatomy. Furthermore, this approach makes it easy to perform subsequent lateral pelvic lymph node dissection.
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Affiliation(s)
- Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Anri Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinnosuke Harata
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kaori Watanabe
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Yanagita
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Suzuki
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hajime Ushigome
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuzo Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuyoshi Shiga
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Robot-Assisted Total Mesorectal Excision Versus Laparoscopic Total Mesorectal Excision: A Retrospective Propensity Score-Matched Cohort Analysis in Experienced Centers. Dis Colon Rectum 2022; 65:218-227. [PMID: 34459449 DOI: 10.1097/dcr.0000000000002031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The superiority of robot-assisted over laparoscopic total mesorectal excision has not been proven. Most studies do not consider the learning curve while comparing the surgical technique. OBJECTIVE This study aims to compare laparoscopic with robot-assisted total mesorectal excision performed by surgeons who completed the learning curve of the technique. DESIGN This is a multicenter retrospective propensity score-matched analysis. SETTINGS The study was performed in 2 large, dedicated robot-assisted hospitals and 5 large, dedicated laparoscopic hospitals. PATIENTS Patients were included if they underwent a robot-assisted or laparoscopic total mesorectal excision for rectal cancer with curative intent at a dedicated center for the minimally invasive technique between January 1, 2015, and December 31, 2017. INTERVENTIONS We compared robot-assisted with laparoscopic total mesorectal excision. MAIN OUTCOME MEASURES The main outcome was conversion to laparotomy during surgery. Secondary outcomes were postoperative morbidity and positive circumferential resection margin. RESULTS A total of 884 patients were included and, after matching, 315 patients per treatment group remained. Conversion was similar between laparoscopic and robot-assisted total mesorectal excision (4.4% vs 2.5% (p = 0.20)). Positive circumferential resection margin was equal (3.2% vs 4.4% (p = 0.41)). Overall morbidity was comparable as well, although a lower rate of wound infections was observed in the robot-assisted group (5.7% vs 1.9% (p = 0.01)). More primary anastomoses were constructed in the robot-assisted group (50.8% vs 68.3% (p < 0.001)). Finally, more open procedures were performed in dedicated laparoscopic centers, with an overrepresentation of cT4N+ tumors in this group. LIMITATIONS This is a retrospective multicenter cohort; however, propensity score matching was applied to control for confounding by indication. CONCLUSIONS Robot-assisted and laparoscopic total mesorectal excision are equally safe in terms of short-term outcomes. However, with the robot-assisted approach, more primary anastomoses were constructed, and a lower wound infection rate was observed. See Video Abstract at http://links.lww.com/DCR/B677.ESCISIÓN MESORRECTAL TOTAL ASISTIDA POR ROBOT VERSUS ESCISIÓN MESORRECTAL TOTAL LAPAROSCÓPICA: UNA PUNTUACIÓN DE PROPENSIÓN RETROSPECTIVA ANÁLISIS DE COHORTES EMPAREJADAS EN CENTROS EXPERIMENTADOS. ANTECEDENTES No se ha demostrado la superioridad de la escisión mesorrectal total asistida por robot sobre la laparoscópica. La mayoría de los estudios no tienen en cuenta la curva de aprendizaje al comparar la técnica quirúrgica. OBJETIVO Este estudio tiene como objetivo comparar la escisión mesorrectal total laparoscópica con la asistida por robot realizada por cirujanos que completaron la curva de aprendizaje de la técnica. DISEO Este es un análisis multicéntrico retrospectivo emparejado por puntuación de propensión. AJUSTES El estudio se realizó en dos grandes hospitales dedicados asistidos por robots y cinco grandes hospitales laparoscópicos dedicados. PACIENTES Se incluyeron pacientes que se sometieron a escisión mesorrectal total asistida por robot o laparoscópica para cáncer de recto con intención curativa, en un centro dedicado a la técnica mínimamente invasiva entre el 1 de enero de 2015 y el 31 de diciembre de 2017. INTERVENCIONES Comparamos la escisión mesorrectal total asistida por robot con la laparoscópica. PRINCIPALES MEDIDAS DE RESULTADO El principal resultado fue la conversión a laparotomía durante la cirugía. Los resultados secundarios fueron la morbilidad posoperatoria y el margen circunferencial positivo. RESULTADOS Se incluyó a un total de 884 pacientes y, después de emparejar, quedaron 315 pacientes por grupo de tratamiento. La conversión fue similar entre la escisión mesorrectal total laparoscópica y asistida por robot (4,4% frente a 2,5% [p = 0,20]). El margen de resección circunferencial positivo fue igual (3,2% vs 4,4% [p = 0,41]). La morbilidad general también fue comparable, aunque se observó una menor tasa de infecciones de heridas en el grupo asistido por robot (5,7% frente a 1,9% [p = 0,01]). Se construyeron más anastomosis primarias en el grupo asistido por robot (50,8% frente a 68,3% [p < 0,001]). Finalmente, se realizaron procedimientos más abiertos en centros laparoscópicos dedicados, con una sobrerrepresentación de tumores cT4N + en este grupo. LIMITACIONES Ésta es una cohorte multicéntrica retrospectiva; sin embargo, se aplicó el emparejamiento por puntuación de propensión para controlar los factores de confusión por indicación. CONCLUSIONES La escisión mesorrectal total asistida por robot y laparoscópica son igualmente seguras en términos de resultados a corto plazo. Sin embargo, con el abordaje asistido por robot, se construyeron más anastomosis primarias y se observó una menor tasa de infección de la herida. Consulte Video Resumen en http://links.lww.com/DCR/B677. (Traducción-Dr. Gonzalo Hagerman).
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Vogel JD, Felder SI, Bhama AR, Hawkins AT, Langenfeld SJ, Shaffer VO, Thorsen AJ, Weiser MR, Chang GJ, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum 2022; 65:148-177. [PMID: 34775402 DOI: 10.1097/dcr.0000000000002323] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | | | | | | | | | | | - Amy J Thorsen
- Colon and Rectal Surgery Associates, Minneapolis, Minnesota
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Maeda A, Takahashi H, Watanabe K, Yanagita T, Suzuki T, Nakai N, Maeda Y, Shiga K, Hirokawa T, Ogawa R, Hara M, Matsuo Y, Takiguchi S. The clinical impact of robot-assisted laparoscopic rectal cancer surgery associated with robot-assisted radical prostatectomy. Asian J Endosc Surg 2022; 15:36-43. [PMID: 34145964 DOI: 10.1111/ases.12961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2021] [Accepted: 05/29/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Robot-assisted laparoscopic surgery has been performed in various fields, especially in the pelvic cavity. However, little is known about the utility of robot-assisted laparoscopic rectal cancer surgery associated with robot-assisted radical prostatectomy (RARP). We herein report the clinical impact of robot-assisted laparoscopic rectal cancer surgery associated with RARP. METHODS We experienced five cases of robot-assisted laparoscopic rectal cancer surgery associated with RARP. One involved robot-assisted laparoscopic abdominoperineal resection with en bloc prostatectomy for T4b rectal cancer, and one involved robot-assisted laparoscopic intersphincteric resection combined with RARP for synchronous rectal and prostate cancer. The remaining three involved robot-assisted laparoscopic low anterior resection (RaLAR) after RARP. For robot-assisted laparoscopic rectal cancer surgery, the da Vinci Xi surgical system was used. RESULTS We could perform planned robotic rectal cancer surgery in all cases. The median operation time was 529 min (373-793 min), and the median blood loss was 307 ml (32-1191 ml). No patients required any transfusion in the intra-operative or immediate peri-operative period. The circumferential resection margin was negative in all cases. There were no complications of grade ≥III according to the Clavien-Dindo classification and no conversions to conventional laparoscopic or open surgery. CONCLUSION Robot-assisted laparoscopic surgery associated with RARP is feasible in patients with rectal cancer. The long-term surgical outcomes remain to be further evaluated.
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Affiliation(s)
- Anri Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kaori Watanabe
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Yanagita
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Suzuki
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nozomu Nakai
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuzo Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuyoshi Shiga
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahisa Hirokawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masayasu Hara
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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The art of robotic colonic resection: a review of progress in the past 5 years. Updates Surg 2021; 73:1037-1048. [PMID: 33481214 PMCID: PMC8184527 DOI: 10.1007/s13304-020-00969-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/28/2020] [Indexed: 01/12/2023]
Abstract
Surgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.
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Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kato S, Hanaoka M. Robotic surgery for clinical T4 rectal cancer: short- and long-term outcomes. Surg Endosc 2021; 36:91-99. [PMID: 33409593 DOI: 10.1007/s00464-020-08241-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal surgical approach for clinical T4 (cT4) rectal cancer is unknown. This study was conducted to clarify short- and long-term outcomes of robotic surgery for cT4 rectal cancer. METHODS In our retrospective cohort study, we enrolled patients who underwent robotic surgery for cT4 rectal cancer within 15 cm from the anal verge between 2011 and 2018. The short- and long-term outcomes were evaluated. RESULTS Of a total of 122 eligible patients, 70 (57%) had cT4a tumors and 52 (43%) had cT4b tumors. Thirty-five patients (29%) had distant metastasis and 21 (17%) underwent preoperative chemoradiotherapy. Thirty-four patients (28%) underwent combined resection of adjacent organs and 43 (35%) underwent lateral lymph node dissection. The median operative time was 288 min and the median blood loss was 11 ml. No patients required conversion to open surgery. The incidences of postoperative complications of grades II, III, and IV or more according to the Clavien-Dindo classification were 17.2%, 3.5%, and 0%, respectively. Seventy-three patients (60%) had pathological T4 tumors, and the incidence of positive resection margins was 4.9%. The median follow-up time was 42.9 months. The 3-year overall survival, disease-free survival, and cumulative local recurrence rates were 87.5%, 70.4%, and 4.0%, respectively. CONCLUSIONS The short- and long-term outcomes of robotic surgery for cT4 rectal cancer were favorable. Robotic surgery is considered to be a useful approach for cT4 rectal cancer.
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Affiliation(s)
- Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shunichiro Kato
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Marie Hanaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Xu M, Zhao Z, Jia B, Liu R, Liu H. Perioperative and long-term outcomes of robot-assisted versus laparoscopy-assisted hemicolectomy for left-sided colon cancers: a retrospective study. Updates Surg 2021; 73:1049-1056. [PMID: 33394355 PMCID: PMC8184556 DOI: 10.1007/s13304-020-00959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022]
Abstract
The objective of this study is to evaluate the perioperative and long-term outcomes of robot-assisted hemicolectomy (RAH) versus laparoscopy-assisted hemicolectomy (LAH) for left-sided colon cancers. Patients who underwent RAH and LAH from January 2012 to December 2018 were reviewed retrospectively. Patient characteristics and perioperative outcomes were compared between the two groups. Follow-up consultations were conducted to evaluate the long-term outcomes of these procedures. A total of 460 patients were included (RAH, n = 205; LAH, n = 255). There was no difference in patient characteristics between the two groups. Compared with the LAH group, the RAH group showed longer operative time (150.23 ± 43.77 min vs. 125.85 ± 38.67 min, p < 0.001) and higher surgery cost (6.33 ± 1.50 vs. 2.88 ± 0.72 thousand $, p < 0.001) and total hospital cost (14.97 ± 3.05 vs. 9.05 ± 2.31 thousand $, p < 0.001). No significant differences in tumor pathology, TNM staging, and perioperative outcomes were observed. There were no obvious differences in the 3-year and 5-year overall survival (OS) or 3-year and 5-year disease-free survival. Cox multivariate analyses showed that age, body mass index, and intravascular cancer embolus were independent risk factors for OS. Moreover, the robotic approach was not an independent risk factor for prognosis of left-sided colon cancers. RAH is an appropriate operation method for left-sided colon cancer, with perioperative and long-term outcomes comparable to those of laparoscopy. Meanwhile, RHA has longer operative time and higher cost.
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Affiliation(s)
- Maolin Xu
- Department of General Surgery II, The First Medical Center of Chinese, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China
| | - Zhiming Zhao
- Department of Hepatobiliary Surgery II, The First Medical Center of Chinese, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China
| | - Baoqing Jia
- Department of General Surgery II, The First Medical Center of Chinese, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China
| | - Rong Liu
- Department of Hepatobiliary Surgery II, The First Medical Center of Chinese, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China.
| | - Hongyi Liu
- Department of General Surgery II, The First Medical Center of Chinese, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China.
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Parascandola SA, Horsey ML, Hota S, Sparks AD, Tampo MMT, Kim G, Obias V. Surgical resection of T4 colon cancers: an NCDB propensity score-matched analysis of open, laparoscopic, and robotic approaches. J Robot Surg 2020; 15:701-710. [PMID: 33104963 DOI: 10.1007/s11701-020-01166-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022]
Abstract
Historically, T4 tumors of the colon have been a contraindication to minimally invasive resection. The purpose of this study was to conduct a National Cancer Database analysis to compare the outcomes after curative treatment for T4 colon cancer between robotic, laparoscopic, and open approaches. The US National Cancer Database was queried for patients with T4 adenocarcinoma of the colon who underwent curative resection. Groups were separated based on approach (open, laparoscopic, robotic). One to one nearest neighbor propensity score matching (PSM) ± 1% caliper was performed across surgical approach cohorts to balance potential confounding covariates. Kaplan-Meier estimation and Cox-proportional hazards regression were used to analyze primary outcome of survival. Secondary outcomes were analyzed by way of logistic regression. Inclusion criteria and PSM identified 876 cases per treatment approach (n = 2628). PSM provided adequate discrimination between treatment cohorts (0.6 < AUC < 0.8) and potential confounding covariates did not significantly differ between cohorts (all respective P > 0.05). Patients who underwent a robotic approach had lower odds of conversion to laparotomy compared to the laparoscopic cohort (P < 0.0001). Laparoscopic and robotic approaches were associated with increased odds of > 12 lymph nodes examined, decreased odds of positive margins, and decreased odds of 30-day readmission, 30-day mortality, and 90-day mortality compared to the open approach. Cox-proportional hazards regression showed that both robotic and laparoscopic approaches were significantly associated with decreased mortality hazards relative to open. Both laparoscopic and robotic-assisted surgeries achieved improved oncologic outcomes and survival compared to open resection of T4 cancers. A robotic-assisted approach was significantly associated with a lower conversion rate compared to the laparoscopic approach. This case-matched study demonstrates safety of using minimally invasive techniques in T4 cancers.
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Affiliation(s)
| | | | - Salini Hota
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Andrew D Sparks
- Department of Surgery, George Washington University Medical Faculty Associates, Washington D.C., USA
| | | | - George Kim
- Department of Hematology and Oncology, George Washington University Hospital, Washington D.C., USA
| | - Vincent Obias
- Department of Colorectal Surgery, George Washington University Hospital, Washington D.C., USA
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Takeyama H, Danno K, Nishigaki T, Yamashita M, Oka Y. Surgical technique for mesorectal division during robot-assisted laparoscopic tumor-specific mesorectal excision (TSME) for rectal cancer using da Vinci Si surgical system: the simple switching technique (SST). Updates Surg 2020; 73:1093-1102. [PMID: 33079354 DOI: 10.1007/s13304-020-00901-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023]
Abstract
In a narrow pelvic cavity, performing sufficient tumor-specific mesorectal excision (TSME) is difficult. Even in robot-assisted laparoscopic surgery (RALS), mesorectal division is difficult in a narrow pelvic cavity. To overcome this difficulty, we invented a novel method of mesorectal division. In this new approach, we switched the fenestrated bipolar forceps and the double-fenestrated forceps with each other so that both instruments were placed on the same (right) side of the patient. After the mesorectal fat and vessels were coagulated using the fenestrated bipolar forceps, coagulated tissues were divided using the monopolar scissors in the same direction. We named this technique the "simple switching technique (SST)". We retrospectively collected data and evaluated the usefulness of SST in 24 consecutive patients who underwent RALS TSME between July 2018 and January 2020. Twelve patients underwent SST, and 12 patients underwent other conventional surgical methods (non-SST). The median operation time for mesorectal division was 809.5 s (range 395-1491 s) in the SST group and 985.5 s (range 493-2353 s) in the non-SST group. The coefficient of variation for non-SST was 0.545, which was > 1.5 times the coefficient of 0.360 for SST. Although no significant differences were found for operation time for mesorectal division, the operation time for mesorectal division by SST tended to be shorter than by non-SST (P = 0.157). No significant differences were found regarding short-term outcomes between the groups. SST is feasible and can be an optional method of mesorectal division in RALS TSME.
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Affiliation(s)
- Hiroshi Takeyama
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan.
| | - Katsuki Danno
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Takahiko Nishigaki
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Yoshio Oka
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
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Takeyama H, Danno K, Nishigaki T, Yamashita M, Yamazaki M, Yamakita T, Nishihara A, Taniguchi H, Mizutani M, Nakamichi I, Yura M, Ikeda K, Oka Y. Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report. Surg Case Rep 2019; 5:156. [PMID: 31654242 PMCID: PMC6814676 DOI: 10.1186/s40792-019-0719-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/27/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Approximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there is a lack of published studies reporting robot-assisted laparoscopic surgery (RALS) after self-expanding metallic stent (SEMS) placement for malignant rectal obstruction (MRO). To our knowledge, this is the first report to do so. CASE PRESENTATION An 80-year-old man with incomplete paralysis of the lower limbs as well as bladder-rectal disorder due to a spine fracture sustained in a fall accident 26 years ago presented with lower abdominal pain and vomiting. Abdominal multi-detector computed tomography revealed an obstructive rectal tumor with distended bowel on the oral side. Emergency colonoscopy was performed, and an SEMS placed. The patency of SEMS and decompression of the distended bowel was confirmed, and elective RALS was performed 29 days after SEMS placement. To our knowledge, this is the first report of RALS after decompression with SEMS placement for MRO. CONCLUSIONS RALS after SEMS placement is a safe and feasible therapeutic strategy for MRO.
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Affiliation(s)
- Hiroshi Takeyama
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan.
| | - Katsuki Danno
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Takahiko Nishigaki
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Masami Yamazaki
- Department of Gastroenterology, Minoh City Hospital, Osaka, 562-0014, Japan
| | - Tsuyoshi Yamakita
- Department of Gastroenterology, Minoh City Hospital, Osaka, 562-0014, Japan
| | - Akihiro Nishihara
- Department of Gastroenterology, Minoh City Hospital, Osaka, 562-0014, Japan
| | - Hirokazu Taniguchi
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Masayo Mizutani
- Department of Gastroenterology, Minoh City Hospital, Osaka, 562-0014, Japan
| | - Itsuko Nakamichi
- Department of Pathology, Minoh City Hospital, Osaka, 562-0014, Japan
| | - Mamoru Yura
- Department of Gastroenterology, Minoh City Hospital, Osaka, 562-0014, Japan
| | - Kimimasa Ikeda
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
| | - Yoshio Oka
- Department of Gastroenterological Surgery, Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan
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