Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results

  • Rogier M. P. H. Crolla
  • Janneke J. C. Tersteeg
  • George P. van der Schelling
  • Jan H. Wijsman
  • Jennifer M. J. Schreinemakers
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Rectal cancer Robot-assisted laparoscopy Multivisceral resection T4 tumours 

References

  1. 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
  2. 2.
    Amin MB (2017) AJCC cancer staging manual, 8th edn. Springer, New YorkCrossRefGoogle Scholar
  3. 3.
    Debove C, Maggiori L, Chau A, Kanso F, Ferron M, Panis Y (2015) What happens after R1 resection in patients undergoing laparoscopic total mesorectal excision for rectal cancer? A study in 333 consecutive patients. Color Dis 17(3):197–204.  https://doi.org/10.1111/codi.12849 CrossRefGoogle Scholar
  4. 4.
    Jörgren F, Johansson R, Damber L, Lindmark G (2010) Risk factors of rectal cancer local recurrence: population-based survey and validation of the Swedish rectal cancer registry. Colorectal Dis 12(10):977–986.  https://doi.org/10.1111/j.1463-1318.2009.01930.x CrossRefPubMedGoogle Scholar
  5. 5.
    Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C (2002) Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 235(2):217–225CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Smith JD, Nash GM, Weiser MR, Temple LK, Guillem JG, Paty PB (2012) Multivisceral resections for rectal cancer. Br J Surg 99(8):1137–1143.  https://doi.org/10.1002/bjs.8820 CrossRefPubMedGoogle Scholar
  7. 7.
    Mañas MJ, Espín E, López-Cano M, Vallribera F, Armengol-Carrasco M (2015) Multivisceral resection for locally advanced rectal cancer: prognostic factors influencing outcome. Scand J Surg 104(3):154–160.  https://doi.org/10.1177/1457496914552341 CrossRefPubMedGoogle Scholar
  8. 8.
    Nagasue Y, Akiyoshi T, Ueno M et al (2013) Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes. J Gastrointest Surg 17(7):1299–1305.  https://doi.org/10.1007/s11605-013-2222-5 CrossRefPubMedGoogle Scholar
  9. 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
  10. 10.
    Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13(2):138–143.  https://doi.org/10.1111/j.1463-1318.2010.02380.x CrossRefPubMedGoogle Scholar
  11. 11.
    de’Angelis N, Landi F, Vitali GC et al (2017) Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. Surg Endosc 31(8):3106–3121.  https://doi.org/10.1007/s00464-016-5332-9 CrossRefPubMedGoogle Scholar
  12. 12.
    Li X, Wang T, Yao L et al (2017) The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: a meta-analysis and systematic review. Medicine 96(29):e7585.  https://doi.org/10.1097/MD.0000000000007585 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Shin JW, Kim J, Kwak JM et al (2014) First report: robotic pelvic exenteration for locally advanced rectal cancer. Color Dis 16(1):O9–O14.  https://doi.org/10.1111/codi.12446 CrossRefGoogle Scholar
  14. 14.
    Gustafsson UO, Scott MJ, Schwenk W et al (2012) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr 31(6):783–800.  https://doi.org/10.1016/j.clnu.2012.08.013 CrossRefPubMedGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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
  17. 17.
    van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218.  https://doi.org/10.1016/S1470-2045(13)70016-0 CrossRefPubMedGoogle Scholar
  18. 18.
    Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer. JAMA 314(13):1356.  https://doi.org/10.1001/jama.2015.12009 CrossRefPubMedGoogle Scholar
  19. 19.
    Vasilescu C, Tudor S, Popa M, Aldea B, Gluck G (2011) Entirely robotic total pelvic exenteration. Surg Laparosc Endosc Percutan Tech 21(4):e200–e202.  https://doi.org/10.1097/SLE.0b013e3182246c17 CrossRefPubMedGoogle Scholar
  20. 20.
    Kawakita H, Katsumata K, Kasahara K et al (2016) A case of advanced rectal cancer in which combined prostate removal and ISR using the da Vinci surgical system with preoperative chemotherapy allowed curative resection. Gan To Kagaku Ryoho 43(12):1629–1631PubMedGoogle Scholar
  21. 21.
    Konstantinidis IT, Chu W, Tozzi F et al (2017) Robotic total pelvic exenteration: video-illustrated technique. Ann Surg Oncol.  https://doi.org/10.1245/s10434-017-6036-7 Google Scholar
  22. 22.
    Kagawa H, Kinugasa Y, Shiomi A et al (2015) Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surg Endosc 29(4):995–1000.  https://doi.org/10.1007/s00464-014-3760-y CrossRefPubMedGoogle Scholar
  23. 23.
    Shin US, Nancy You Y, Nguyen AT et al (2016) Oncologic outcomes of extended robotic resection for rectal cancer. Ann Surg Oncol 23(7):2249–2257.  https://doi.org/10.1245/s10434-016-5117-3 CrossRefPubMedGoogle Scholar
  24. 24.
    Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351.  https://doi.org/10.1016/j.surg.2009.10.012 CrossRefPubMedGoogle Scholar
  25. 25.
    Chen K, Cao G, Chen B et al (2017) Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality Nonrandomized Studies in the last 5 years. Int J Surg 39:1–10.  https://doi.org/10.1016/j.ijsu.2016.12.123 CrossRefPubMedGoogle Scholar
  26. 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
  27. 27.
    Sun Z, Adam MA, Kim J, Shenoi M, Migaly J, Mantyh CR (2016) Optimal timing to surgery after neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Am Coll Surg 222(4):367–374.  https://doi.org/10.1016/j.jamcollsurg.2015.12.017 CrossRefPubMedGoogle Scholar
  28. 28.
    Foster JD, Jones EL, Falk S, Cooper EJ, Francis NK (2013) Timing of surgery after long-course neoadjuvant chemoradiotherapy for rectal cancer. Dis Colon Rectum 56(7):921–930.  https://doi.org/10.1097/DCR.0b013e31828aedcb CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rogier M. P. H. Crolla
    • 1
  • Janneke J. C. Tersteeg
    • 1
  • George P. van der Schelling
    • 1
  • Jan H. Wijsman
    • 1
  • Jennifer M. J. Schreinemakers
    • 1
  1. 1.Department of Oncological SurgeryAmphia HospitalBredaThe Netherlands

Personalised recommendations