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Robotic-assisted surgery may be a useful approach to protect urinary function in the modern era of diverse surgical approaches for rectal cancer

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Abstract

Background

Urinary dysfunction (UD) remains a significant complication of rectal cancer surgery. In modern surgical treatment for rectal cancer, multiple operative approaches are used. Such approaches include open, laparoscopic, and robotic-assisted surgery; and multiple procedures, including anterior, intersphincteric, and abdominoperineal resection. Thus, modern surgical treatments for rectal cancer have diversified. This study aimed to identify risk factors for early UD (EUD) after total mesorectal excision (TME) and to explore the methods for decreasing postoperative EUD in diverse surgical treatments for rectal cancer.

Methods

In our retrospective cohort study, we enrolled patients with lower rectal cancer who underwent TME alone at a single high-volume cancer center between 2010 and 2017. EUD was defined as the presence of ≥ 50 mL residual urine volume. Multivariate analysis was performed to determine clinicopathological factors significantly associated with postoperative EUD.

Results

Of a total of 337 eligible patients, 32 patients (10%) had postoperative EUD. Multivariate analysis revealed that only the operative approach (laparoscopic surgery: odds ratio [OR], 8.93; 95% confidence interval [CI], 2.94–27.14, open surgery: OR, 11.55; 95% CI 2.10–63.83) was significantly associated with an increase in postoperative EUD. Robotic-assisted surgery was associated with significant reduction in postoperative EUD.

Conclusion

Only robotic-assisted surgery was inversely correlated with postoperative EUD. Robotic-assisted surgery may be a useful approach to protect urinary function in lower rectal cancer surgery.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Yusuke Yamaoka, Hiroyasu Kagawa, Akio Shiomi, Yushi Yamakawa, Hitoshi Hino, Shoichi Manabe & Yusuke Kinugasa

  2. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Yusuke Kinugasa

Authors
  1. Yusuke Yamaoka
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  2. Hiroyasu Kagawa
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  3. Akio Shiomi
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  4. Yushi Yamakawa
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  5. Hitoshi Hino
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  6. Shoichi Manabe
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  7. Yusuke Kinugasa
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Correspondence to Hiroyasu Kagawa.

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Disclosures

Drs. Yusuke Yamaoka, Hiroyasu Kagawa, Akio Shiomi, Yushi Yamakawa, Hitoshi Hino, Shoichi Manabe, and Yusuke Kinugasa and have no conflicts of interest or financial ties to disclose.

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Yamaoka, Y., Kagawa, H., Shiomi, A. et al. Robotic-assisted surgery may be a useful approach to protect urinary function in the modern era of diverse surgical approaches for rectal cancer. Surg Endosc 35, 1317–1323 (2021). https://doi.org/10.1007/s00464-020-07509-4

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