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Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery

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Abstract

Background

Most previous studies of intersphincteric resection (ISR) adopted a two-stage procedure involving abdominal and transanal approaches. We performed completely abdominal ISR via open and a robot-assisted (RA) approaches as treatments for lower rectal cancer (LRC). The RA approach might enable deep dissection and facilitate ISR in patients with restrictive pelvic anatomy.

Methods

A consecutive cohort of 222 LRC patients who underwent completely abdominal ISR (RA ISR, n = 108; open ISR, n = 114) was enrolled prospectively, and their short-term outcomes were evaluated.

Results

In a multivariate analysis, ISR was performed more frequently in the RA than in the open group (82.6 vs. 67.9 %, p = 0.008). The number of harvested lymph nodes was >12 in both groups. A positive distal resection margin was not observed in either group, and a positive circumferential resection margin was found in one patient in the RA group. Overall morbidity did not differ between the groups. Moderate to severe sexual dysfunction occurred 2.7-fold more frequently in the open group (p = 0.023) among male patients ≤65 years. Mean Wexner’s fecal incontinence scores at postoperative months 6 and 12 were greater in the open group than in the RA group (p < 0.05).

Conclusions

Completely abdominal ISR may be feasible in the treatment of LRC, based on a short-term study. Furthermore, RA ISR had equivalent oncological outcomes and slightly improved functional recovery relative to open ISR.

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References

  1. Guillem JG, Chessin DB, Shia J, Suriawinata A, Riedel E, Moore HG, Minsky BD, Wong WD (2007) A Prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation. Ann Surg 245:88–93

    Article  PubMed Central  PubMed  Google Scholar 

  2. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, Cohen AM, Guillem JG (2003) Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 10:80–85

    Article  PubMed  Google Scholar 

  3. Kwak JY, Kim CW, Lim SB, Yu CS, Kim TW, Kim JH, Jang SJ, Kim JC (2012) Oncologically safe distal resection margins in rectal cancer patients treated with chemoradiotherapy. J Gastrointest Surg 16:1947–1954

    Article  PubMed  Google Scholar 

  4. Tilney HS, Tekkis PP (2008) Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectal cancer. Colorectal Dis 10:3–15

    Article  CAS  PubMed  Google Scholar 

  5. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  6. Martin ST, Heneghan HM, Winter DC (2012) Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg 99:603–612

    Article  CAS  PubMed  Google Scholar 

  7. 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 246:916–922

    Article  PubMed  Google Scholar 

  8. Ito M, Saito N, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y (2009) Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Dis Colon Rectum 52:64–70

    Article  PubMed  Google Scholar 

  9. Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gullà N, Giustozzi G, Sciannameo F, Noya G, Boselli C (2012) Laparoscopic vs. open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 14:e277–e296

    Article  CAS  PubMed  Google Scholar 

  10. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82

    Article  CAS  PubMed  Google Scholar 

  11. Park JS, Choi GS, Jun SH, Hasegawa S, Sakai Y (2011) Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg 254:941–946

    Article  PubMed  Google Scholar 

  12. Kim JC, Yang SS, Jang TY, Kwak JY, Yun MJ, Lim SB (2012) Open versus robot-assisted sphincter-saving operations in rectal cancer patients: techniques and comparison of outcomes between groups of 100 matched patients. Int J Med Robot 8:468–475

    Article  PubMed  Google Scholar 

  13. Kim JC, Kim CW, Yoon YS, Lee HO, Park IJ (2012) Levator-sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology. Surg Today 42:547–553

    Article  PubMed  Google Scholar 

  14. Lawson EH, Curet MJ, Sanchez BR, Schuster R, Berguer R (2007) Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robotic Surg 1:61–67

    Article  Google Scholar 

  15. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  16. Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. 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 Central  PubMed  Google Scholar 

  19. van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP, Broeders IA (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23:1365–1371

    Article  PubMed Central  PubMed  Google Scholar 

  20. American Joint Committee on Cancer (2010) Colon and rectum. In: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) AJCC cancer staging manual. Springer, New York, pp 143–164

    Chapter  Google Scholar 

  21. Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A (2008) Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg 251:882–886

    Article  Google Scholar 

  22. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP (2013) Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc 27:48–55

    Article  PubMed  Google Scholar 

  23. Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F (2007) Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg 94:341–345

    Article  CAS  PubMed  Google Scholar 

  24. Rondelli F, Reboldi P, Rulli A, Barberini F, Guerrisi A, Izzo L, Bolognese A, Covarelli P, Boselli C, Becattini C, Noya G (2009) Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta- analysis. Int J Colorectal Dis 24:479–488

    Article  CAS  PubMed  Google Scholar 

  25. Weiser MR, Quah HM, Shia J, Guillem JG, Paty PB, Temple LK, Goodman KA, Minsky BD, Wong WD (2009) Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg 249:236–242

    Article  PubMed  Google Scholar 

  26. Lim SW, Huh JW, Kim YJ, Kim HR (2011) Laparoscopic intersphincteric resection for low rectal cancer. World J Surg 35:2811–2817

    Article  PubMed  Google Scholar 

  27. Vaizey CJ, Carapeti E, Cahill JH, Kamm MA (1999) Prospective comparison of fecal incontinence grading systems. Gut 44:77–80

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, Sonzogni A, Biffi R (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 257:672–678

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by Grants (to J.C. Kim) from the Asan Institute for Life Sciences (2013-069 and 9-490), the Korea Research Foundation (2013R1A2A1A03070986), Ministry of Science, ICT, and Future Planning, and the Korea Health 21 R&D Project (HI06C0868 and HI13C1750), Ministry of Health, Welfare, and Family Affairs, Republic of Korea. We gratefully acknowledge the expert assistance of M. J. Yoon and Y. J. Yoon.

Disclosures

Drs. J. C. Kim, S.-B. Lim, Y. S. Yoon, I. J. Park, C. W. Kim, and C. N. Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Colorectal Division, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Korea

    Jin C. Kim, Seok-B. Lim, Yong S. Yoon, In J. Park & Chan W. Kim

  2. Department of Surgery, Eulji Medical School, Taejon, Korea

    Chang N. Kim

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  1. Jin C. Kim
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  2. Seok-B. Lim
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Correspondence to Jin C. Kim.

Electronic supplementary material

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464_2014_3509_MOESM1_ESM.tif

Supplementary Fig. 1A The 6 ports are generally used, comprising one assistant port. The 12 mm camera port is placed about 1 cm right and cephalad to the umbilicus and a 0° camera is utilized during the entire procedure. B Completion of docking the cart with arms (1–3) in their respective position. AP ports used during abdominopelvic procedure, P ports used during pelvic procedure, MCL mid-clavicular line, SUL spino-umbilical line. (TIFF 6,084 kb)

Supplementary Video-clip 1 An operation view of the completely abdominal intersphincteric resection in a 40-year-old male patient with lower rectal cancer. (WMV 93,271 kb)

Supplementary Video-clip 2 The final procedure using laparoscopy-assisted double stapling anastomosis after completely abdominal intersphincteric resection in a 70-year-old female patient with lower rectal cancer. (WMV 30,188 kb)

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Kim, J.C., Lim, SB., Yoon, Y.S. et al. Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery. Surg Endosc 28, 2734–2744 (2014). https://doi.org/10.1007/s00464-014-3509-7

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  • DOI: https://doi.org/10.1007/s00464-014-3509-7

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