Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results
Radical resection by multivisceral resection of colorectal T4 tumours is important to reduce local recurrence and improve survival. Oncological safety of laparoscopic resection of T4 tumours is controversial. However, robot-assisted resections might have advantages, such as 3D view and greater range of motion of instruments. The aim of this study is to evaluate the initial results of robot-assisted resection of T4 rectal and distal sigmoid tumours.
This is a cohort study of a prospectively kept database of all robot-assisted rectal and sigmoid resections between 2012 and 2017. Patients who underwent a multivisceral resection for tumours appearing as T4 cancer during surgery were included. Rectal and sigmoid resections are routinely performed with the DaVinci robot, unless an indication for intra-operative radiotherapy exists.
28 patients with suspected T4 rectal or sigmoid cancer were included. Most patients (78%) were treated with neoadjuvant chemoradiotherapy (n = 19), short course radiotherapy with long waiting interval (n = 2) or chemotherapy (n = 1). En bloc resection was performed with the complete or part of the invaded organ (prostate, vesicles, bladder, abdominal wall, presacral fascia, vagina, uterus, adnex). In 3 patients (11%), the procedure was converted to laparotomy. Twenty-four R0-resections were performed (86%) and four R1-resections (14%). Median length of surgery was 274 min (IQR 222–354). Median length of stay was 6 days (IQR 5–11). Twelve patients (43%) had postoperative complications: eight (29%) minor complications and four (14%) major complications. There was no postoperative mortality.
Robot-assisted laparoscopy seems to be a feasible option for the resection of clinical T4 cancer of the distal sigmoid and rectum in selected cases. Radical resections can be achieved in the majority of cases. Therefore, T4 tumours should not be regarded as a strict contraindication for robot-assisted surgery.
KeywordsRectal cancer Robot-assisted laparoscopy Multivisceral resection T4 tumours
- 1.WCS (ed) (1997) TNM Classification of Malignant Tumors, 5th Edition. LH, New York: John Wiley & Sons, Inc.; International Union Against Cancer (UICC)Google Scholar
- 9.Kim KY, Hwang DW, Park YK, Lee HS (2012) A single surgeon’s experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely? Surg Endosc 26(2):493–500. https://doi.org/10.1007/s00464-011-1907-7 CrossRefPubMedGoogle Scholar
- 16.Jayne D, Pigazzi A, Marshall H et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. JAMA 318(16):1569. https://doi.org/10.1001/jama.2017.7219 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Probst CP, Becerra AZ, Aquina CT et al (2015) Extended intervals after neoadjuvant therapy in locally advanced rectal cancer: the key to improved tumor response and potential organ preservation. J Am Coll Surg 221(2):430–440. https://doi.org/10.1016/j.jamcollsurg.2015.04.010 CrossRefPubMedPubMedCentralGoogle Scholar