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Robot-assisted intersphincteric resection facilitates an efficient sphincter-saving in patients with low rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Few investigations of robot-assisted intersphincteric resection (ISR) are presently available to support this procedure as a safe and efficient procedure. We aimed to evaluate the utility of robot-assisted ISR by comparison between ISR and abdominoperineal resection (APR) using both robot-assisted and open approaches.

Methods

The 558 patients with lower rectal cancer (LRC) who underwent curative operation was enrolled between July 2010 and June 2015 to perform either by robot-assisted (ISR vs. APR = 310 vs. 34) or open approaches (144 vs. 70). Perioperative and functional outcomes including urogenital and anorectal dysfunctions were measured. Recurrence and survival were examined in 216 patients in which >3 years had elapsed after the operation.

Results

The robot-assisted approach was the most significant parameter to determine ISR achievement among potent parameters (OR = 3.467, 95% CI = 2.095–5.738, p < 0.001). Early surgical complications occurred more frequently in the open ISR group (16 vs. 7.7%, p = 0.01). The voiding and male sexual dysfunctions were significantly more frequent in the open ISR (p < 0.05). The fecal incontinence and lifestyle alteration score was greater in the open ISR than in the robot-assisted ISR at 12 and 24 months, respectively (p < 0.05). However, the 3-year cumulative rates of local recurrence and survival did not differ between the two groups.

Conclusions

The current procedure of robot-assisted ISR replaced a significant portion of APR to achieve successful SSO via mostly transabdominal approach and double-stapled anastomosis. The robot-assisted ISR with minimal invasiveness might be a help to reduce anorectal and urogenital dysfunctions.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine and Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jin Cheon Kim, Jong Lyul Lee, Abdulrahman Muaod Alotaibi, Yong Sik Yoon, Chan Wook Kim & In Ja Park

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  1. Jin Cheon Kim
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  2. Jong Lyul Lee
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  3. Abdulrahman Muaod Alotaibi
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  4. Yong Sik Yoon
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  5. Chan Wook Kim
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  6. In Ja Park
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Correspondence to Jin Cheon Kim.

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Electronic supplementary material

Supplementary Fig 1

Completely trans-abdominal ISR (A) and trans-abdominal ISR combined with trans-anal ISR. Longitudinal sections demonstrate evenly dissected circumferential margin in the former (A, right) and curvilinear or layered one in the latter (B, left). ① mucosa and submucosa, ② internal anal sphincter, ③ intersphincteric longitudinal muscle. (GIF 290 kb)

High resolution image (TIFF 3140 kb)

Supplementary Table 1

Parameters associated delayed operative time during robot-assisted ISR. (DOCX 17 kb)

Supplementary Table 2

Parameters associated with an increased incontinence score at postoperative 6, 12, and 24 months in patients who underwent robot-assisted ISR. (DOCX 19 kb)

Supplementary Table 3

Parameters associated with an increased incontinence score at postoperative 6, 12, and 24 months in patients who underwent open ISR. (DOCX 18 kb)

Supplementary video-clip 1

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Kim, J.C., Lee, J.L., Alotaibi, A.M. et al. Robot-assisted intersphincteric resection facilitates an efficient sphincter-saving in patients with low rectal cancer. Int J Colorectal Dis 32, 1137–1145 (2017). https://doi.org/10.1007/s00384-017-2807-7

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  • DOI: https://doi.org/10.1007/s00384-017-2807-7

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