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01-11-2018

Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results

Authors: Rogier M. P. H. Crolla, Janneke J. C. Tersteeg, George P. van der Schelling, Jan H. Wijsman, Jennifer M. J. Schreinemakers

Published in: Surgical Endoscopy | Issue 11/2018

Abstract

Background

Radical resection by multivisceral resection of colorectal T4 tumours is important to reduce local recurrence and improve survival. Oncological safety of laparoscopic resection of T4 tumours is controversial. However, robot-assisted resections might have advantages, such as 3D view and greater range of motion of instruments. The aim of this study is to evaluate the initial results of robot-assisted resection of T4 rectal and distal sigmoid tumours.

Methods

This is a cohort study of a prospectively kept database of all robot-assisted rectal and sigmoid resections between 2012 and 2017. Patients who underwent a multivisceral resection for tumours appearing as T4 cancer during surgery were included. Rectal and sigmoid resections are routinely performed with the DaVinci robot, unless an indication for intra-operative radiotherapy exists.

Results

28 patients with suspected T4 rectal or sigmoid cancer were included. Most patients (78%) were treated with neoadjuvant chemoradiotherapy (n = 19), short course radiotherapy with long waiting interval (n = 2) or chemotherapy (n = 1). En bloc resection was performed with the complete or part of the invaded organ (prostate, vesicles, bladder, abdominal wall, presacral fascia, vagina, uterus, adnex). In 3 patients (11%), the procedure was converted to laparotomy. Twenty-four R0-resections were performed (86%) and four R1-resections (14%). Median length of surgery was 274 min (IQR 222–354). Median length of stay was 6 days (IQR 5–11). Twelve patients (43%) had postoperative complications: eight (29%) minor complications and four (14%) major complications. There was no postoperative mortality.

Conclusions

Robot-assisted laparoscopy seems to be a feasible option for the resection of clinical T4 cancer of the distal sigmoid and rectum in selected cases. Radical resections can be achieved in the majority of cases. Therefore, T4 tumours should not be regarded as a strict contraindication for robot-assisted surgery.

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Title: Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results
Authors: Rogier M. P. H. Crolla
Janneke J. C. Tersteeg
George P. van der Schelling
Jan H. Wijsman
Jennifer M. J. Schreinemakers
Publication date: 01-11-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6210-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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