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Oncological and anorectal functional outcomes of robot-assisted intersphincteric resection in lower rectal cancer, particularly the extent of sphincter resection and sphincter saving

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Abstract

Background

Few investigations to date assessing the effectiveness of robot-assisted intersphincteric resection (ISR) have included sufficient patients and follow-up period. This study assessed the utility and safety of robot-assisted ISR by comparing groups of patients who underwent low anterior resection (LAR) with or without ISR and ISR extent.

Methods

This study enrolled 897 patients who underwent curative LAR between 2010 and 2017. Patients were divided into those who did (ISR+) and did not (ISR−) undergo ISR, with the former group subdivided by ISR extent (partial, subtotal, and total). Tumor recurrence and survival were compared in the two groups by one-to-one nearest neighbor matching (218 patients each).

Results

Robot-assisted ISR was performed via an entirely transabdominal approach in 93% of patients who underwent LAR. The rate of circumferential margin positivity was ≤ 2% in all patients and did not differ in the ISR− and ISR+ groups or in the three ISR+ subgroups. Mean fecal incontinence score and manometric values deteriorated significantly during postoperative until 12–24 months (p < 0.05 to < 0.001), but recovered subsequently. The 5-year cumulative rates of local recurrence in the ISR+ and ISR− groups were 2.5% and 2.9%, respectively (p = 0.731). The 5-year cumulative rates of overall (86.7% vs. 84.2%, p = 0.899) and disease-free (80.7% vs. 78.5%, p = 0.934) survival did not differ significantly in the ISR+ and ISR− groups.

Conclusions

Because ISR involves resection of low-lying tumors and complex pelvic dissection, robot-assisted ISR via a mostly transabdominal procedure may be technically more efficient, providing lasting anorectal function and good oncologic outcomes.

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Acknowledgments

The authors thank Hyun Joo Jeong, RN, and Jung Rang Kim, RN, for their efforts in functional evaluation, data collection, and coordination at the Colorectal Physiology Laboratory.

Funding

This work was supported in part by a Grant (to J.C. Kim) from the Korea Research Foundation (Grant No. 2016R1E1A1A02919844), Ministry of Science and ICT, Republic of Korea.

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Authors and Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Jin Cheon Kim, Jong Lyul Lee, Joon Woo Bong, Ji Hyun Seo & Chan Wook Kim

  2. Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Seong Ho Park

  3. Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

    Jihoon Kim

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

    Jin Cheon Kim

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Correspondence to Jin Cheon Kim.

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Jin Cheon Kim, Jong Lyul Lee, Joon Woo Bong, Ji Hyun Seo, Chan Wook Kim, Seong Ho Park, and Jihoon Kim declare that they have no conflict of interest or financial ties to disclose.

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Supplementary material 1 (DOCX 52 kb)

464_2019_6989_MOESM2_ESM.tif

Supplementary Figure 1 Flow diagram showing the serial inclusion and exclusion of patients for the current analysis. CRC, colorectal cancer; IBD, inflammatory bowel disease; NET, neuroendocrine tumor; SCC, squamous cell carcinoma; GIST, gastrointestinal stromal tumor; ISR, intersphincteric resection; APR, abdominoperineal resection; LEAPR, levator excision abdominoperineal resection; FIS, fecal incontinence score; PSM, propensity score matching. (TIFF 1436 kb)

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Kim, J.C., Lee, J.L., Bong, J.W. et al. Oncological and anorectal functional outcomes of robot-assisted intersphincteric resection in lower rectal cancer, particularly the extent of sphincter resection and sphincter saving. Surg Endosc 34, 2082–2094 (2020). https://doi.org/10.1007/s00464-019-06989-3

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