Advertisement

Surgical Endoscopy

, Volume 31, Issue 11, pp 4466–4471 | Cite as

Anorectal complications after robotic intersphincteric resection for low rectal cancer

  • Li-Jen KuoEmail author
  • James Chi-Yong Ngu
  • Yan-Jiun Huang
  • Yen-Kuang Lin
  • Chia-Che Chen
  • Yiu-Shun Tong
  • Szu-Chia Huang
  • Chia-Chen Hu
  • Shu-Hwa Tan
Article

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.

Keywords

Anal stenosis Intersphincteric resection Mucosal prolapse Rectal cancer Robotic surgery 

Notes

Compliance with ethical standards

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.

References

  1. 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):4354–4359CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Pourhoseingholi MA (2012) Increased burden of colorectal cancer in Asia. World J Gastrointest Oncol 4(4):68–70CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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 8:163–169Google Scholar
  4. 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 10:80–85CrossRefPubMedGoogle Scholar
  5. 5.
    Ruo L, Guillen JG (1999) Major 20th-century advancements in the management of rectal cancer. Dis Colon Rectum 42:563–578CrossRefPubMedGoogle Scholar
  6. 6.
    Schootman M, Hendren S, Ratnapradipa K, Stringer L, Davidson NO (2016) Adoption of robotic technology for treating colorectal cancer. Dis Colon Rectum 59:1101–1108CrossRefGoogle Scholar
  7. 7.
    Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81:1376–1378CrossRefPubMedGoogle Scholar
  8. 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–e98CrossRefPubMedGoogle Scholar
  9. 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–S428CrossRefPubMedGoogle Scholar
  10. 10.
    Pucciani F (2013) A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updates Surg 65:257–263CrossRefPubMedGoogle Scholar
  11. 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–e679CrossRefPubMedGoogle Scholar
  12. 12.
    Martin ST, Heneghan HM, Winter DC (2012) Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg 99:603–612CrossRefPubMedGoogle Scholar
  13. 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 13:638–643CrossRefPubMedGoogle Scholar
  14. 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 97:2282–2289CrossRefPubMedGoogle Scholar
  15. 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 246:916–921CrossRefPubMedGoogle Scholar
  16. 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 76:579–585CrossRefPubMedGoogle Scholar
  17. 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 85:355–358CrossRefPubMedGoogle Scholar
  18. 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 66:1219–1227CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Li-Jen Kuo
    • 1
    • 2
    Email author
  • James Chi-Yong Ngu
    • 3
  • Yan-Jiun Huang
    • 1
    • 4
  • Yen-Kuang Lin
    • 5
  • Chia-Che Chen
    • 6
  • Yiu-Shun Tong
    • 6
  • Szu-Chia Huang
    • 7
  • Chia-Chen Hu
    • 1
  • Shu-Hwa Tan
    • 8
  1. 1.Division of Colorectal Surgery, Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan
  2. 2.Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.Department of SurgeryChangi General HospitalSingaporeSingapore
  4. 4.The Ph.D. Program for Translational Medicine, College of Medical Science and TechnologyTaipei Medical University and Academia SinicaTaipeiTaiwan
  5. 5.Biostatistics and Research Consultation CenterTaipei Medical UniversityTaipeiTaiwan
  6. 6.Division of Acute Care Surgery and Traumatology, Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan
  7. 7.Department of Physical Medicine and RehabilitationTaipei Medical University HospitalTaipeiTaiwan
  8. 8.Department of NursingTaipei Medical University HospitalTaipeiTaiwan

Personalised recommendations