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Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision

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Abstract

Background

Despite mechanical and technical improvements in laparoscopic and robot-assisted (LAR) rectal cancer procedures, the absence of prognostic disparities among various approaches cannot improve the quality of TME. The present study re-evaluated robot-assisted total mesorectal excision (TME) procedures to determine whether these procedures may reveal technical faults that may increase the rate of local recurrence (LR).

Methods

This study enrolled 886 consecutive patients with rectal cancer, who underwent curative robot-assisted LAR at Asan Medical Center (Seoul, Korea) between July 2010 and August 2017 (the first vs second period; n = 399 vs 487). The quality of TME and lateral pelvic mesorectal excision (LPME) were analyzed, as were LR rates and survival outcomes.

Results

Complete TME and LPME were achieved in 89.2% and 80.1% of these patients, respectively, with ≤ 1% having incomplete TME excluding intramesorectal excision. LR rates were 13.5 and 14.5 times higher in patients with incomplete TME and LPME, respectively, than in patients with complete TME and LPME (14.8% vs 1.1% and 8.7% vs 0.6%; p < 0.001 each by univariate analyses). Multivariate analyses showed that defective LPME was independently associated with incomplete TME and vice versa (p < 0.001). Cox regression analysis showed that defective LPME was independently correlated with reduced 5-year disease-free survival rate (hazard ratio, 1.563; 95% confidence interval, 1.052–2.323; p = 0.027).

Conclusions

LR in rectal cancer patients was largely due to incomplete LPME, which was significantly associated with incomplete TME. Complete LPME may enhance the likelihood of complete TME, reducing LR rates.

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Acknowledgements

The authors would like to thank Hyun Joo Jeong, RN, and Jung Rang Kim, RN, for their help with data enrollment, collection, and update.

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Authors and Affiliations

  1. 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, Korea

    Jin Cheon Kim, Jin Su Han, Jong Lyul Lee, Chan Wook Kim & Yong Sik Yoon

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

    Sung Ho Park

  3. Department of Pathology, University of Ulsan College of Medicine, Seoul, Korea

    Jihun Kim

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  1. Jin Cheon Kim
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Correspondence to Jin Cheon Kim.

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J. C. Kim, J. S. Han, J. L. Lee, C. W. Kim, Y. S. Yoon, S. H. Park, and J. Kim confirm they have no conflicts of interest or financial ties to disclose.

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Kim, J.C., Han, J.S., Lee, J.L. et al. Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision. Surg Endosc 35, 5450–5460 (2021). https://doi.org/10.1007/s00464-020-08032-2

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