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Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy

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Abstract

Background

A robotic system (da Vinci® Surgical System, Intuitive Surgical Inc., Sunnyvale, CA, USA) has technical advantages over conventional laparoscopic surgery because it increases the precision and accuracy of anatomical dissection. The present study aimed to compare the short-term outcomes between robot-assisted intersphincteric resection (ISR) and laparoscopic ISR for distal rectal cancer.

Methods

Patients who underwent robot- or laparoscopy-assisted ISR for rectal cancer between March 2008 and July 2011 were included in this retrospective comparative study. Perioperative and postoperative data, including complications and early functional outcomes, were analyzed between the two groups. Functional outcomes were evaluated using the Wexner scoring system, the International Prostate Symptom Score, and the 5-item version of the International Index of Erectile Function.

Results

A total of 40 patients underwent robot-assisted and 40 underwent laparoscopic ISR. The mean operative time was significantly longer in the robotic group than in the laparoscopic group (235.5 vs. 185.4 min; p < 0.001). Transabdominal ISR, in which intersphincteric dissection is completed in the pelvic cavity, was performed more with robotic assistance than with laparoscopic surgery (8 vs. 2 cases; p = 0.043). No difference was observed between groups regarding postoperative morbidity and pathological outcomes. The robot-assisted group showed a trend toward less postoperative blood loss and early recovery of functional outcomes.

Conclusion

Robot-assisted surgery was safe and effective for ISR of distal rectal cancer and showed surgical outcomes similar to those of the latest laparoscopic ISR. The favorable results of the robot-assisted ISR included reduced adaptation time, alleviated difficulty of perineal phase, and early recovery of functional outcomes in this analysis of short-term clinical outcomes.

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References

  1. Ueno H, Mochizuki H, Hashiguchi Y, Ishikawa K, Fujimoto H, Shinto E, Hase K (2004) Preoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancer. Ann Surg 239:34–42

    Article  PubMed  Google Scholar 

  2. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469

    Article  PubMed  Google Scholar 

  3. Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Gohl J (2006) The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis 8:23–33

    Article  PubMed  CAS  Google Scholar 

  4. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81:1376–1378

    Article  PubMed  CAS  Google Scholar 

  5. Saito N, Ono M, Sugito M, Ito M, Morihiro M, Kosugi C, Sato K, Kotaka M, Nomura S, Arai M, Kobatake T (2004) Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum 47:459–466

    Article  PubMed  Google Scholar 

  6. Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, Tiret E (2007) Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 246:916–921 discussion 921–922

    Article  PubMed  Google Scholar 

  7. Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M (2009) Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 52:1065–1071

    Article  PubMed  Google Scholar 

  8. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  9. Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425

    Article  PubMed  Google Scholar 

  10. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192

    Article  PubMed  Google Scholar 

  11. Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61

    Article  PubMed  Google Scholar 

  12. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451

    Article  PubMed  CAS  Google Scholar 

  13. Ballantyne GH (2002) Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc 16:1389–1402

    Article  PubMed  CAS  Google Scholar 

  14. Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  PubMed  CAS  Google Scholar 

  15. Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835

    Article  PubMed  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes 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  PubMed  Google Scholar 

  17. Hamada M, Matsumura T, Matsumoto T, Teraishi F, Ozaki K, Nakamura T, Fukui Y, Nishioka Y, Taniki T, Horimi T (2011) Video. Advantages of the laparoscopic approach for intersphincteric resection. Surg Endosc 25:1661–1663

    Article  PubMed  Google Scholar 

  18. Christophe L, Paumet T, Fabien L, Denost Q, Eric R (2012) Intersphincteric resection for low rectal cancer: laparoscopic versus open approach. Colorectal Dis 14:35–41 discussion 42–43

    Article  Google Scholar 

  19. Marks J, Mizrahi B, Dalane S, Nweze I, Marks G (2010) Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 24:2700–2707

    Article  PubMed  CAS  Google Scholar 

  20. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708

    Article  PubMed  CAS  Google Scholar 

  21. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 54:151–156

    Article  PubMed  Google Scholar 

  22. Park JS, Choi GS, Lim KH, Jang YS, Jun SH (2010) Robotic-assisted versus laparoscopic surgery for low rectal cancer: case-matched analysis of short-term outcomes. Ann Surg Oncol 17:3195–3202

    Article  PubMed  Google Scholar 

  23. Schiessel R, Novi G, Holzer B, Rosen HR, Renner K, Holbling N, Feil W, Urban M (2005) Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 48:1858–1865 discussion 1865–1867

    Article  PubMed  Google Scholar 

  24. Chandra V, Nehra D, Parent R, Woo R, Reyes R, Hernandez-Boussard T, Dutta S (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839

    Article  PubMed  Google Scholar 

  25. Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR (2002) Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 60:39–45 discussion 45

    Article  PubMed  Google Scholar 

  26. Stefanidis D, Wang F, Korndorffer JR Jr, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382

    Article  PubMed  Google Scholar 

  27. Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734

    Article  PubMed  Google Scholar 

  28. Hassan I, Larson DW, Cima RR, Gaw JU, Chua HK, Hahnloser D, Stulak JM, O’Byrne MM, Larson DR, Wolff BG, Pemberton JH (2006) Long-term functional and quality of life outcomes after coloanal anastomosis for distal rectal cancer. Dis Colon Rectum 49:1266–1274

    Article  PubMed  Google Scholar 

  29. Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M (2007) Functional results of intersphincteric resection for low rectal cancer. Br J Surg 94:1272–1277

    Article  PubMed  CAS  Google Scholar 

  30. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487

    Article  PubMed  Google Scholar 

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Disclosure

Soo Yeun Park, Gyu-Seog Choi, Jun Seok Park, Hye Jin Kim, and Jong-Pil Ryuk have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Colorectal Cancer Center, Kyungpook National University Medical Center, Daegu, Korea

    Soo Yeun Park, Jun Seok Park, Hye Jin Kim & Jong-Pil Ryuk

  2. Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 474 Hakjeongdong, Buk-gu, Daegu, 702-210, Korea

    Gyu-Seog Choi

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  1. Soo Yeun Park
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Correspondence to Gyu-Seog Choi.

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Park, S.Y., Choi, GS., Park, J.S. et al. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc 27, 48–55 (2013). https://doi.org/10.1007/s00464-012-2405-2

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  • DOI: https://doi.org/10.1007/s00464-012-2405-2

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