Skip to main content

Advertisement

SpringerLink
Log in

Robotic surgery for clinical T4 rectal cancer: short- and long-term outcomes

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The optimal surgical approach for clinical T4 (cT4) rectal cancer is unknown. This study was conducted to clarify short- and long-term outcomes of robotic surgery for cT4 rectal cancer.

Methods

In our retrospective cohort study, we enrolled patients who underwent robotic surgery for cT4 rectal cancer within 15 cm from the anal verge between 2011 and 2018. The short- and long-term outcomes were evaluated.

Results

Of a total of 122 eligible patients, 70 (57%) had cT4a tumors and 52 (43%) had cT4b tumors. Thirty-five patients (29%) had distant metastasis and 21 (17%) underwent preoperative chemoradiotherapy. Thirty-four patients (28%) underwent combined resection of adjacent organs and 43 (35%) underwent lateral lymph node dissection. The median operative time was 288 min and the median blood loss was 11 ml. No patients required conversion to open surgery. The incidences of postoperative complications of grades II, III, and IV or more according to the Clavien–Dindo classification were 17.2%, 3.5%, and 0%, respectively. Seventy-three patients (60%) had pathological T4 tumors, and the incidence of positive resection margins was 4.9%. The median follow-up time was 42.9 months. The 3-year overall survival, disease-free survival, and cumulative local recurrence rates were 87.5%, 70.4%, and 4.0%, respectively.

Conclusions

The short- and long-term outcomes of robotic surgery for cT4 rectal cancer were favorable. Robotic surgery is considered to be a useful approach for cT4 rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Oxford

    Google Scholar 

  2. Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Engstrom PF, Grem JL, Grothey A, Hochster HS, Hoffe S, Hunt S, Kamel A, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Mulcahy MF, Murphy JD, Nurkin S, Saltz L, Sharma S, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Wuthrick E, Gregory KM, Gurski L, Freedman-Cass DA (2018) Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16:874–901

    Article  Google Scholar 

  3. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D, ESMO Guidelines Committee (2017) Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:iv22–iv40

    Article  CAS  Google Scholar 

  4. Dayal S, Battersby N, Cecil T (2017) Evolution of surgical treatment for rectal cancer: a review. J Gastrointest Surg 21:1166–1173

    Article  Google Scholar 

  5. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318:1569–1580

    Article  Google Scholar 

  6. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645

    Article  Google Scholar 

  7. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, Colorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  Google Scholar 

  8. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT Investigators (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363

    Article  CAS  Google Scholar 

  9. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314:1346–1355

    Article  CAS  Google Scholar 

  10. Crolla RMPH, Tersteeg JJC, van der Schelling GP, Wijsman JH, Schreinemakers JMJ (2018) Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results. Surg Endosc 32:4571–4457

    Article  Google Scholar 

  11. Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255:1129–1134

    Article  Google Scholar 

  12. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42

    Article  Google Scholar 

  13. Yamaoka Y, Kagawa H, Shiomi A, Yamakawa Y, Hino H, Manabe S, Kinugasa Y (2020) 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. https://doi.org/10.1007/s00464-020-07509-4

    Article  PubMed  Google Scholar 

  14. Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H (2014) Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Colorectal Dis 29:1105–1111

    Article  Google Scholar 

  15. Hino H, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Numata M, Furutani A, Yamaoka Y, Manabe S, Suzuki T, Kato S (2017) Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center. Tech Coloproctol 21:879–886

    Article  CAS  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  17. Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furutani A, Manabe S, Yamaoka Y, Hino H (2018) Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 32:4498–4505

    Article  Google Scholar 

  18. de′Angelis N, Landi F, Vitali GC, Memeo R, Martínez-Pérez A, Solis A, Assalino M, Vallribera F, Mercoli HA, Marescaux J, Mutter D, Ris F, Espin E, Brunetti F (2017) Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. Surg Endosc 31:3106–3121

    Article  Google Scholar 

  19. Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13:138–143

    Article  CAS  Google Scholar 

  20. Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z (2019) Laparoscopic versus conventional open surgery in T4 rectal cancer: a case-control study. J Minim Access Surg 15:37–41

    Article  Google Scholar 

  21. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774

    Article  Google Scholar 

  22. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  CAS  Google Scholar 

  23. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Wilson K, Hague W, Simes J, Australasian Gastro-Intestinal Trials Group (AGITG) ALaCaRT investigators (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg 269:596–602

    Article  Google Scholar 

  24. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, Peters WR Jr, Maun DC, Chang GJ, Herline A, Fichera A, Mutch MG, Wexner SD, Whiteford MH, Marks J, Birnbaum E, Margolin DA, Larson DW, Marcello PW, Posner MC, Read TE, Monson JRT, Wren SM, Pisters PWT, Nelson H (2019) Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 269:589–595

    Article  Google Scholar 

  25. Shin US, Nancy You Y, Nguyen AT, Bednarski BK, Messick C, Maru DM, Dean EM, Nguyen ST, Hu CY, Chang GJ (2016) Oncologic outcomes of extended robotic resection for rectal cancer. Ann Surg Oncol 23:2249–2257

    Article  Google Scholar 

  26. Shiomi A, Kinugasa Y, Yamaguchi T, Kagawa H, Yamakawa Y (2016) Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31:1701–1710

    Article  Google Scholar 

  27. Sakamoto J, Hamada C, Yoshida S, Kodaira S, Yasutomi M, Kato T, Oba K, Nakazato H, Saji S, Ohashi Y (2007) An individual patient data meta-analysis of adjuvant therapy with uracil-tegafur (UFT) in patients with curatively resected rectal cancer. Br J Cancer 96:1170–1177

    Article  CAS  Google Scholar 

  28. Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY, Chun HK (2016) Clinically suspected T4 colorectal cancer may be resected using a laparoscopic approach. BMC Cancer 16:714

    Article  Google Scholar 

  29. Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H (2016) Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 30:721–728

    Article  Google Scholar 

  30. Japanese Society for Cancer of the Colon and Rectum (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma, third English edition. Kanehara & CO, Ltd, Tokyo

    Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

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, Akio Shiomi, Hiroyasu Kagawa, Hitoshi Hino, Shoichi Manabe, Shunichiro Kato & Marie Hanaoka

Authors
  1. Yusuke Yamaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akio Shiomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroyasu Kagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hitoshi Hino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shoichi Manabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shunichiro Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marie Hanaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Yamaoka.

Ethics declarations

Disclosures

Dr. Yusuke Yamaoka, Dr. Akio Shiomi, Dr. Hiroyasu Kagawa, Dr. Hino Hitoshi, Dr. Shoichi Manabe, Dr. Shunichiro Kato, and Dr. Marie Hanaoka have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamaoka, Y., Shiomi, A., Kagawa, H. et al. Robotic surgery for clinical T4 rectal cancer: short- and long-term outcomes. Surg Endosc 36, 91–99 (2022). https://doi.org/10.1007/s00464-020-08241-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08241-9

Keywords

Search

Navigation