Skip to main content

Advertisement

SpringerLink
Log in

Robotic surgery with high dissection and low ligation technique for consecutive patients with rectal cancer following preoperative concurrent chemoradiotherapy

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

We present the preliminary experiences with and short-term outcomes of 50 consecutive patients with rectal cancer who underwent preoperative concurrent chemoradiotherapy (CCRT) followed by robotic surgery by using the high dissection and low ligation technique.

Methods

Between October 2013 and August 2015, 50 patients with rectal cancer underwent robotic surgery after preoperative CCRT at a single institution. We performed D3 lymph node dissection and low tie ligation of the inferior mesenteric artery (IMA); this technique is referred to as the high dissection and low ligation technique. Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed.

Results

FOLFOX regimen was used for preoperative CCRT in 26 (52 %) patients. Long-course radiotherapy was concurrently administered. A pathological complete response (pCR) was obtained in 14 (28 %) patients. Of the 50 patients, 23 (46 %) patients received intersphincteric resection (ISR) with coloanal anastomosis, 25 (50 %) patients received lower anterior resection (LAR), and 2 (4 %) patients received abdominoperineal resection (APR). Apical nodes were pathologically harvested in 47 (94 %) patients, and the median number of harvested apical lymph nodes was 2 (range, 0–10). The overall complication rate was 24 % (10 patients with 12 episodes), and most complications were mild.

Conclusion

Roboic rectal surgery combined with appropriate preoperative CCRT helps in achieving a favorable pCR, circumferential resection margin, and sphincter preservation. Moreover, high dissection and low ligation of the IMA can be safely performed using the da Vinci® Surgical System safely which yield favorable short-term clinical outcomes.

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. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

    Article  CAS  PubMed  Google Scholar 

  2. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  3. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rödel C (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933

    Article  CAS  PubMed  Google Scholar 

  4. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study Group (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  CAS  PubMed  Google Scholar 

  5. Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–94

    Article  PubMed  Google Scholar 

  6. Baek JH, Pastor C, Pigazzi A (2010) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25:521–525

    Article  PubMed  Google Scholar 

  7. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2011) S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25:240–248

    Article  PubMed  Google Scholar 

  8. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19:2485–2493

    Article  PubMed  Google Scholar 

  9. Hellan M, Ouellette J, Lagares-Garcia JA, Rauh SM, Kennedy HL, Nicholson JD, Nesbitt D, Johnson CS, Pigazzi A (2015) Robotic rectal cancer resection: a retrospective multicenter analysis. Ann Surg Oncol 22:2151–2158

    Article  PubMed  Google Scholar 

  10. Huang CW, Yeh YS, Ma CJ, Choy TK, Huang MY, Huang CM, Tsai HL, Hsu WH, Wang JY (2015) Robotic colorectal surgery for laparoscopic surgeons with limited experience: preliminary experiences for 40 consecutive cases at a single medical center. BMC Surg 15:73

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kim YS, Kim MJ, Park SC, Sohn DK, Kim DY, Chang HJ, Nam BH, Oh JH (2015) Robotic versus laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy: case-matched study of short-term outcomes. Cancer Res Treat. doi:10.4143/crt.2014.365

    Google Scholar 

  12. Saklani AP, Lim DR, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2013) Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Colorectal Dis 28:1689–98

    Article  PubMed  Google Scholar 

  13. Lange MM, Buunen M, van de Velde CJ, Lange JF (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 51:1139–1145

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chen CW, Chen MJ, Yeh YS, Tsai HL, Chang YT, Lu CY, Shih YL, Sun LC, Wang JY (2013) Intraoperative anastomotic dye test significantly decrease anastomotic leaks in patients with rectal cancers receiving resection. Techniques in Coloproctology 17:579–583

    Article  PubMed  Google Scholar 

  15. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumors, 7th edn. Wiley-Liss Inc., New York, pp 100–105

    Google Scholar 

  16. Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  CAS  PubMed  Google Scholar 

  17. Baik SH, Lee WJ, Rha KH, Kim NK, Sohn SK, Chi HS, Cho CH, Lee SK, Cheon JH, Ahn JB, Kim WH (2008) Robotic total mesorectal excision for rectal cancer using four robotic arms. Surg Endosc 22:792–797

    Article  PubMed  Google Scholar 

  18. Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, Sonzogni A, Biffi R (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257:672–678

    Article  PubMed  Google Scholar 

  19. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 54:151–156

    Article  PubMed  Google Scholar 

  20. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487

    Article  PubMed  Google Scholar 

  21. Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A (2010) Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg 251:882–886

    Article  PubMed  Google Scholar 

  22. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17:3195–3202

    Article  PubMed  Google Scholar 

  23. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93:1215–1223

    Article  CAS  PubMed  Google Scholar 

  24. Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, Ackland SP, Schache D, McClure B, McLachlan SA, McKendrick J, Leong T, Hartopeanu C, Zalcberg J, Mackay J (2012) Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 30:3827–3833

    Article  PubMed  Google Scholar 

  25. Wallace MH, Glynne-Jones R (2007) Saving the sphincter in rectal cancer: are we prepared to change practice? Colorectal Dis 9:302–308

    Article  CAS  PubMed  Google Scholar 

  26. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774

    Article  PubMed  Google Scholar 

  27. Chou JF, Row D, Gonen M, Liu YH, Schrag D, Weiser MR (2010) Clinical and pathologic factors that predict lymph node yield from surgical specimens in colorectal cancer: a population-based study. Cancer 116:2560–2570

    Article  PubMed  PubMed Central  Google Scholar 

  28. Persiani R, Biondi A, Gambacorta MA, Bertucci Zoccali M, Vecchio FM, Tufo A, Coco C, Valentini V, Doglietto GB, D’Ugo D (2014) Prognostic implications of the lymph node count after neoadjuvant treatment for rectal cancer. Br J Surg 101:133–142

    Article  CAS  PubMed  Google Scholar 

  29. Cirocchi R, Trastulli S, Farinella E, Desiderio J, Vettoretto N, Parisi A, Boselli C, Noya G (2012) High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed. Surg Oncol 21:e111–123

    Article  PubMed  Google Scholar 

  30. Liang JT, Lai HS (2014) Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer. Surg Endosc 28:1727–1733

    Article  PubMed  Google Scholar 

  31. Ubukata M, Itabashi M, Kameoka S (2014) Japanese D3 lymph node dissection in low rectal cancer with inferior mesenteric lymph node metastases. World J Surg 38:2724–2729

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from the Excellence for Cancer Research Center Grant through funding by the Ministry of Science and Technology (MOST104-2325-B-037-001) and the Ministry of Health and Welfare (MOHW105-TDU-B-212-134007), Health and welfare surcharge of tobacco products, Taiwan, Republic of China as well as grants from Kaohsiung Medical University Hospital (KMUH104-4M29, KMUHS10422, KMUHS10405, KMUHS10418), the Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University (KMU-TP104C00, KMU-TP104C03, KMU-TP104C04, KMU-TP104C07, KMU-TP104A11, KMU-PT10422, KMU-DK105001), and the Grant of Biosignature in Colorectal Cancers, Academia Sinica, Taiwan.

Author information

Authors and Affiliations

  1. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Wen Huang, Hsiang-Lin Tsai & Jaw-Yuan Wang

  2. Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Wen Huang

  3. Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Wen Huang, Yung-Sung Yeh, Hsiang-Lin Tsai & Jaw-Yuan Wang

  4. Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yung-Sung Yeh

  5. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wei-Chih Su

  6. Division of General Surgery Medicine, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Lin Tsai

  7. Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Lin Tsai & Jaw-Yuan Wang

  8. Division of Colorectal Surgery, Department of Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan

    Tak-Kee Choy

  9. Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ming-Yii Huang & Chun-Ming Huang

  10. Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ming-Yii Huang

  11. Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    I-Chen Wu, Huang-Ming Hu, Wen-Hung Hsu & Yu-Chung Su

  12. Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    I-Chen Wu, Huang-Ming Hu, Wen-Hung Hsu & Yu-Chung Su

  13. Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jaw-Yuan Wang

Authors
  1. Ching-Wen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yung-Sung Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei-Chih Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hsiang-Lin Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tak-Kee Choy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ming-Yii Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chun-Ming Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. I-Chen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Huang-Ming Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wen-Hung Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yu-Chung Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jaw-Yuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaw-Yuan Wang.

Ethics declarations

Disclosure

Drs. Ching-Wen Huang, Yung-Sung Yeh, Wei-Chih Su, Hsiang-Lin Tsai, Tak-Kee Choy, Ming-Yii Huang, Chun-Ming Huang, I-Chen Wu, Huang-Ming Hu, Wen-Hung Hsu, Yu-Chung Su, and Jaw-Yuan Wang have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, CW., Yeh, YS., Su, WC. et al. Robotic surgery with high dissection and low ligation technique for consecutive patients with rectal cancer following preoperative concurrent chemoradiotherapy. Int J Colorectal Dis 31, 1169–1177 (2016). https://doi.org/10.1007/s00384-016-2581-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2581-y

Keywords

Search

Navigation