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Annals of Surgical Oncology

, Volume 14, Issue 11, pp 3168–3173 | Cite as

Short-Term Outcomes After Robotic-Assisted Total Mesorectal Excision for Rectal Cancer

  • Minia Hellan
  • Casandra Anderson
  • Joshua D. I. Ellenhorn
  • Benjamin Paz
  • Alessio PigazziEmail author
Gastrointestinal Oncology Original Papers

Abstract

Background

Laparoscopic total mesorectal excision for rectal cancer remains a difficult procedure with high conversion rates. We have sought to improve on some of the pitfalls of laparoscopy by using the DaVinci robotic system. Here we report our two-year experience with robotic-assisted laparoscopic surgery for primary rectal cancer.

Methods

A prospectively maintained database of all rectal cancer cases starting in November 2004 was created. A series of 39 consecutive unselected patients with primary rectal cancer was analyzed. Clinical and pathologic outcomes were reviewed retrospectively.

Results

22 patients had low anterior, 11 intersphincteric and six abdominoperineal resections. Postoperative mortality and morbidity were % and 12.8%, respectively. The median operative time was 285 minutes (range 180–540 mins). The conversion rate was 2.6%. A total mesorectal excision with negative circumferential and distal margins was accomplished in all patients, and a median of 13 (range 7–28) lymph nodes was removed. The anastomotic leak rate was 12.1%. The median hospital stay was 4 days. There have been no local recurrences at a median follow-up of 13 months.

Conclusions

Robotic-assisted surgery for rectal cancer can be carried out safely and according to oncological principles. This approach shows promising short-term outcomes and may facilitate the adoption of minimally invasive rectal surgery.

Keywords

Total mesorectal excision Minimally invasive surgery Robotic-assisted Rectal cancer 

References

  1. 1.
    Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon cancer. Consensus of the European Association of Endoscopic Surgery (E.A.E.S). Surg Endosc 2004; 18:1163–85PubMedCrossRefGoogle Scholar
  2. 2.
    The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050–9CrossRefGoogle Scholar
  3. 3.
    Guillou PJ, Quirke P, Thorpe H, et al. MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 2005; 365:1718–26PubMedCrossRefGoogle Scholar
  4. 4.
    Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004; 363:1187–92PubMedCrossRefGoogle Scholar
  5. 5.
    Zhou ZG, Hu M, Li Y, et al. Laparoscopic vs. open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 2004; 18:1211–5PubMedCrossRefGoogle Scholar
  6. 6.
    Morino M, Parini U, Giraudo G, Salval M, Contul RB, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003; 237:335–42PubMedCrossRefGoogle Scholar
  7. 7.
    Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2004; 18:281–9PubMedCrossRefGoogle Scholar
  8. 8.
    Barlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 2005; 19:757–66PubMedCrossRefGoogle Scholar
  9. 9.
    Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR. Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 2001; 44:315–21PubMedCrossRefGoogle Scholar
  10. 10.
    Morino M, Allaix ME, Giraudo G, Corno F, Garrone C. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 2005; 19:1460–7PubMedCrossRefGoogle Scholar
  11. 11.
    Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 2006; 13:413–24PubMedCrossRefGoogle Scholar
  12. 12.
    Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 2005; 19:892–6PubMedCrossRefGoogle Scholar
  13. 13.
    Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg 2004; 239:14–21PubMedCrossRefGoogle Scholar
  14. 14.
    Patel VR, Chammas MF Jr, Shah S. Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract 2007; 61:309–14PubMedCrossRefGoogle Scholar
  15. 15.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 2006; 20:1521–5PubMedCrossRefGoogle Scholar
  16. 16.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133:894–9PubMedCrossRefGoogle Scholar
  17. 17.
    Ballantyne GH, Moll F. The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. Surg Clin North Am 2003; 83:1293–1304PubMedCrossRefGoogle Scholar
  18. 18.
    Stylopoulos N, Rattner D. Robotics and ergonomics. Surg Clin North Am 2003; 83:1321–37PubMedCrossRefGoogle Scholar
  19. 19.
    D’Annibale A, Morpurgo E, Fiscon V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 2004; 47:2162–8PubMedCrossRefGoogle Scholar
  20. 20.
    Rockall TA, Darzi A. Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am 2003; 83:1463–8PubMedCrossRefGoogle Scholar
  21. 21.
    Munz Y, Moorthy K, Kudchadkar R, et al. Robotic assisted rectopexy. Am J Surg 2004; 187:88–92PubMedCrossRefGoogle Scholar
  22. 22.
    Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 2006; 20:1713–8PubMedCrossRefGoogle Scholar
  23. 23.
    Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003; 138:777–84PubMedCrossRefGoogle Scholar
  24. 24.
    Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003; 170:1738–41PubMedCrossRefGoogle Scholar
  25. 25.
    Tsang WW, Chung CC, Kwog SY, Li MK. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 2006; 243:35–38CrossRefGoogle Scholar
  26. 26.
    Morgan BJ, Heald RJ. Risk factors for, and management of anastomotic leakage in rectal surgery. Colorectal Dis 2001; 3:135–7CrossRefGoogle Scholar
  27. 27.
    Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998; 85:526–9PubMedCrossRefGoogle Scholar
  28. 28.
    Moloo H, Mamazza J, Poulin EC, et al. Laparoscopic resections for colorectal cancer: Does conversion affect survival? Surg Endosc 2004; 18:732–5PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Minia Hellan
    • 1
  • Casandra Anderson
    • 1
  • Joshua D. I. Ellenhorn
    • 1
  • Benjamin Paz
    • 1
  • Alessio Pigazzi
    • 1
    Email author
  1. 1.Department of General and Oncologic SurgeryCity of Hope National Medical CenterDuarteUSA

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