Skip to main content

Advertisement

SpringerLink
Log in

Anorectal complications after robotic intersphincteric resection for low rectal cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR.

Methods

The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed.

Results

Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23–89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41–162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007).

Conclusions

This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Meyer JE, Narang T, Schnoll-Sussman FH, Pochapin MB, Christos PJ, Sherr DL (2010) Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer 116(18):4354–4359

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pourhoseingholi MA (2012) Increased burden of colorectal cancer in Asia. World J Gastrointest Oncol 4(4):68–70

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kuvshinoff B, Maghfoor I, Miedema B, Bryer M, Westgate S, Wilkes J, Ota D (2000) Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinoma: are ≤ 1 cm distal margins sufficient? Ann Surg Oncol 8:163–169

    Google Scholar 

  4. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D et al (2003) Adequacy of 1 cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 10:80–85

    Article  PubMed  Google Scholar 

  5. Ruo L, Guillen JG (1999) Major 20th-century advancements in the management of rectal cancer. Dis Colon Rectum 42:563–578

    Article  CAS  PubMed  Google Scholar 

  6. Schootman M, Hendren S, Ratnapradipa K, Stringer L, Davidson NO (2016) Adoption of robotic technology for treating colorectal cancer. Dis Colon Rectum 59:1101–1108

    Article  Google Scholar 

  7. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81:1376–1378

    Article  CAS  PubMed  Google Scholar 

  8. Kuo LJ, Hung CS, Wu CH, Wang W, Tam KW, Liang HH, Chang YJ, Wei PL (2011) Oncological and functional outcomes of intersphincteric resection for low rectal cancer. J Surg Res 170:e93–e98

    Article  PubMed  Google Scholar 

  9. Koyama M, Murata A, Sakamoto Y, Morohashi H, Takahashi S, Yoshida E, Hakamada K (2014) Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol 21(Suppl 3):S422–S428

    Article  PubMed  Google Scholar 

  10. Pucciani F (2013) A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updates Surg 65:257–263

    Article  PubMed  Google Scholar 

  11. Maris A, Penninckx F, Devreese AM, Staes F, Moons P, Van Cutsem E, Haustermans K, D‘Hoore A (2013) Persisting anorectal dysfunction after rectal cancer surgery. Colorectal Dis 15:e672–e679

    Article  CAS  PubMed  Google Scholar 

  12. Martin ST, Heneghan HM, Winter DC (2012) Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg 99:603–612

    Article  CAS  PubMed  Google Scholar 

  13. Barisic G, Markovic V, Popovic M, Dimitrijevic I, Gavrilovic P, Krivokapic Z (2011) Function after intersphincteric resection for low rectal cancer and its influence on quality of life. Colorectal Dis 13:638–643

    Article  CAS  PubMed  Google Scholar 

  14. van Duijvendijk P, Slors JF, Taat CW (2002) Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 97:2282–2289

    Article  PubMed  Google Scholar 

  15. Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, Tiret E (2007) Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 246:916–921

    Article  PubMed  Google Scholar 

  16. Lipska MA, Bissett IP, Parry BR, Merrie AE (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76:579–585

    Article  PubMed  Google Scholar 

  17. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  CAS  PubMed  Google Scholar 

  18. Baeten CI, Castermans K, Lammering G, Hillen F, Griffioen AW, Baeten CG (2006) Effects of radiotherapy and chemotherapy on angiogenesis and leukocyte infiltration in rectal cancer. Int J Radiat Oncol Biol Phys 66:1219–1227

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan

      Li-Jen Kuo, Yan-Jiun Huang & Chia-Chen Hu

    2. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

      Li-Jen Kuo

    3. Department of Surgery, Changi General Hospital, Singapore, Singapore

      James Chi-Yong Ngu

    4. The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan

      Yan-Jiun Huang

    5. Biostatistics and Research Consultation Center, Taipei Medical University, Taipei, Taiwan

      Yen-Kuang Lin

    6. Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan

      Chia-Che Chen & Yiu-Shun Tong

    7. Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan

      Szu-Chia Huang

    8. Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan

      Shu-Hwa Tan

    Authors
    1. Li-Jen Kuo
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. James Chi-Yong Ngu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yan-Jiun Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Yen-Kuang Lin
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Chia-Che Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Yiu-Shun Tong
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Szu-Chia Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Chia-Chen Hu
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Shu-Hwa Tan
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Li-Jen Kuo.

    Ethics declarations

    Disclosure

    Dr. Li-Jen Kuo, Dr. James Chi-Yong Ngu, Dr. Yan-Jiun Huang, Mr. Yen-Kuang Lin, Dr. Chia-Che Chen, Dr. Yiu-Shun Tong, Ms. Szu-Chia Huang, Ms. Chia-Chen Hu and Ms. Shu-Hwa Tan have no conflicts of interest or financial ties to disclose.

    Additional information

    Li-Jen Kuo and Yan-Jiun Huang contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Kuo, LJ., Ngu, J.CY., Huang, YJ. et al. Anorectal complications after robotic intersphincteric resection for low rectal cancer. Surg Endosc 31, 4466–4471 (2017). https://doi.org/10.1007/s00464-017-5499-8

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00464-017-5499-8

    Keywords

    Search

    Navigation