Robotic surgery with high dissection and low ligation technique for consecutive patients with rectal cancer following preoperative concurrent chemoradiotherapy
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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.
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.
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.
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.
KeywordsRobotic surgery Rectal cancer Preoperative concurrent chemoradiotherapy High dissection and low ligation Apical node
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.
Compliance with ethical standards
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.
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