Top

Published in:

01-08-2020 | Rectal Cancer | Original Article

The long-term oncological outcomes of the 140 robotic sphincter-saving total mesorectal excision for rectal cancer: a single surgeon experience

Authors: Vusal Aliyev, Handan Tokmak, Suha Goksel, Serhat Meric, Sami Acar, Hakan Kaya, Oktar Asoglu

Published in: Journal of Robotic Surgery | Issue 4/2020

Abstract

Robotic surgery became more popularly in the colorectal surgical field. The aim of the study was to evaluate of the oncological outcomes which patients who underwent the robotic total mesorectal excision for rectal cancer. A series of 140 consecutive patients who underwent robotic rectal surgery between January 2012 and June 2019 was analyzed retrospectively in terms of demographics, pathological data, and surgical and oncological outcomes. There were 104 (74.28%) male and 36 (25.71%) female patients. The tumor was located in the lower rectum in 84 (60%) cases, in the mid rectum in 38 (27.14%) cases, and in the upper rectum in 18 (12.85%) cases. Ninety-eight (70%) of the patients has received neoadjuvant chemoradiotherapy. All the patients underwent robotic sphincter-preserving surgery, 101 (72.14%) patients low-anterior resection, and 39 (27.85%) patients underwent intersphincteric resection with colo-anal anastomosis. There were no conversions. The circumferential resection margin was positive in five (3.57%) patients. The median distal resection margin of the operative specimen was 3.2 (0.2–7) cm. The median number of retrieved lymph nodes was 22 (16–42). TME quality in the in our study was rated as complete in 88.57% (n124) of patients, nearly complete in 7.14% (n10) of patients; and 4.28% (n6) of incomplete. The median hospital stay was 3.5 (3–12) days. In-hospital and 1-month mortality was zero. The median length of follow-up was 40 (2–80) months. The 5-year overall survival rate was 92.78%. The 5-year disease-free survival rate was 90%. Locally recurrence and distance recurrence rate was 3.57% (n5/140) and 2.85% (n4/140), respectively. Robotic rectal cancer surgery has a good oncological outcomes and feasible tool in the field of the rectal surgery, but required a steep learning curve.

Daniels IR, Fisher SE, Heald RJ, Moran BJ (2007) Accurate staging, selective preoperative therapy, and optimal surgery improves outcome in rectal cancer: a review of the recent evidence. Colorectal Dis 9:290–301CrossRef

Kapiteijn E, Putter H, van de Velde CJ, Cooperative investigators of the Dutch ColoRectal Cancer Group (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 89:1142–1149CrossRef

Martling A, Holm T, Rutqvist LE et al (2005) Impact of a surgical training program on rectal cancer outcomes in Stockholm. Br J Surg 92:225–229CrossRef

Wibe A, Møller B, Norstein J et al (2002) Norwegian rectal cancer group. A national strategic change in treatment policy for rectal cancer–implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 45:857–866CrossRef

Minsky BD, Cohen AM, Kemeny N et al (1993) The efficacy of preoperative 5-fluorouracil, high-dose leucovorin, and sequential radiation therapy for unresectable rectal cancer. Cancer 71:3486–3492CrossRef

Theodoropoulos G, Wise WE, Padmanabhan A et al (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45:895–903CrossRef

Staudacher C, Vignali A (2010) Laparoscopic surgery for rectal cancer: the state of the art. World J Gastrointest Surg 2:275–282CrossRef

Poon JT, Law WL (2009) Laparoscopic resection for rectal cancer: a review. Ann Surg Oncol 16:3038–3047CrossRef

Guillou PJ, Quirke P, Thorpe P et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726CrossRef

10.

Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the medical research council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82CrossRef

11.

van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218CrossRef

12.

Caudle AS, Hunt KK, Tucker SL et al (2012) American College of surgeons oncology group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol 19(10):3144–3151. https://doi.org/10.1245/s10434-012-2531-z CrossRefPubMedPubMedCentral

13.

Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the alacart randomized clinical trial. JAMA 314(13):1356–1363CrossRef

14.

Baik SH, Kwon HY, Kim JS et al (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487CrossRef

15.

Bianchi PP, Ceriani C, Locatelli A et al (2010) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 24:2888–2889CrossRef

16.

Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999CrossRef

17.

Asoglu O, Tokmak H, Bakir B, Aliyev V, Saglam S et al (2019) Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes. J Robot Surg. https://doi.org/10.1007/s11701-019-01001-5 CrossRefPubMed

18.

Clancy C, O’Leary DP, Burke JP, Redmond HP, Cofey JC, Kerin MJ, Myers E (2015) A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Colorectal Dis 17(6):482–490CrossRef

19.

Corrigan N, Marshall H, Croft J, Copeland J, Jayne D, Brown J (2018) Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection. Trials 19:33CrossRef

20.

Asoglu O, Kunduz E, Rahmi Serin K et al (2014) Standardized laparoscopic sphincter preserving total mesorectal excision for rectal cancer: long-term oncologic outcome in 217 unselected consecutive patients. Surg Laparosc Endosc Percutan Tech 24:145–152CrossRef

21.

Bademler S, Koza KB, Ucuncu MZ, Tokmak H, Bakir B, Oral EN, Asoglu O (2019) Standardized laparoscopic sphincter-preserving total mesorectal excision for rectal cancer: median of 10 years long-term oncologic outcome in 217 unselected consecutive patients. Surg Laparosc Endosc Percutan Tech. https://doi.org/10.1097/sle.0000000000000664 CrossRefPubMed

22.

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

23.

Saklani AP, Lim DR, Hur H et al (2013) Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Colorectal Dis 28:1689–1698CrossRef

24.

Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL (2019) Efects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials. Asian J Surg 42(6):657–666CrossRef

25.

Benjamin Hopkins M, Geiger Timothy M, Bethurum Alva J, Ford Molly M, Muldoon Roberta L, Beck David E et al (2019) Comparing pathologic outcomes for robotic versus laparoscopic Surgery in rectal cancer resection: a propensity adjusted analysis of 7616 patients. Surg Endosc. https://doi.org/10.1007/s00464-019-07032-1 CrossRefPubMed

26.

Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C et al (2018) Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol 25(12):3572–3579CrossRef

27.

Kim MJ, Park SC, Park JW, Chang HJ et al (2018) Robot-assisted versus laparoscopic surgery for rectal cancer a phase II open label prospective randomized controlled trial. Ann Surg 267(2):243–251CrossRef

28.

Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee H (2015) Short and long-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer. Medicine 94(11):e522CrossRef

29.

Serin KR, Gultekin FA, Batman B, Ay S, Kapran Y, Saglam S, Asoglu O (2015) Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison short-term outcomes. J Robotic Surg 9(3):187–194CrossRef

30.

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 20:1729–1734CrossRef

31.

Wasserberg N, Gutman H (2008) Resection margins in modern rectal cancer surgery. J Surg Oncol 98(611–615):26

32.

Tilney HS, Rasheed S, Northover JM, Tekkis PP (2005) The influence of circumferential resection margins on long-term outcomes following rectal cancer surgery. Dis Colon Rectum 52(1723–1729):29

33.

Pai A, Marecik SJ, Park JJ, Melich G, Sulo S, Prasad LM (2015) Oncologic and clinicopathologic outcomes of robot-assisted total mesorectal excision for rectal cancer. Dis Colon Rectum 58:659–667. https://doi.org/10.1097/DCR.0000000000000385 CrossRefPubMed

34.

Kim CN, Bae SU, Lee SG, Yang SH, Hyun IG, Jang JH et al (2016) Clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer: initial results in a center for minimally invasive surgery. Int J Color Dis 31:843–852. https://doi.org/10.1007/s00384-016-2544-3 CrossRef

35.

Feroci F, Vannucchi A, Bianchi PP, Cantafio S, Garzi A, Formisano G et al (2016) Total mesorectal excision for mid and low rectal cancer: laparoscopic vs robotic surgery. World J Gastroenterol 22:3602–3610. https://doi.org/10.3748/wjg.v22.i13.3602 CrossRefPubMedPubMedCentral

36.

Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137. https://doi.org/10.1097/SLA.0000000000000613 CrossRefPubMed

37.

Hara M, Sng K, Yoo BE, Shin JW, Lee DW, Kim SH (2014) Robotic-assisted surgery for rectal adenocarcinoma: short-term and midterm outcomes from 200 consecutive cases at a single institution. Dis Colon Rectum 57:570–577. https://doi.org/10.1097/DCR.0000000000000088 CrossRefPubMed

Title: The long-term oncological outcomes of the 140 robotic sphincter-saving total mesorectal excision for rectal cancer: a single surgeon experience
Authors: Vusal Aliyev
Handan Tokmak
Suha Goksel
Serhat Meric
Sami Acar
Hakan Kaya
Oktar Asoglu
Publication date: 01-08-2020
Publisher: Springer London
Keywords: Rectal Cancer
Rectal Cancer
Published in: Journal of Robotic Surgery / Issue 4/2020
Print ISSN: 1863-2483
Electronic ISSN: 1863-2491
DOI: https://doi.org/10.1007/s11701-019-01037-7

At a glance: The STEP trials

Springer Medicine

The long-term oncological outcomes of the 140 robotic sphincter-saving total mesorectal excision for rectal cancer: a single surgeon experience

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2020

Variation in the utilization of robotic surgical operations

Modified simple prostatectomy: an approach to address large volume BPH and associated prostate cancers

Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

Initial experience with extraperitoneal robotic-assisted simple prostatectomy using the da Vinci SP surgical system

The ongoing dilemma in pelvic lymph node dissection during radical prostatectomy: who should decide and in which patients?

Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?