Robotic Surgery in Distal Sigmoid and Rectal Carcinoma—A New Option in the Attempt to Solve Previous Problems
DOI:
https://doi.org/10.14748/0d288818Keywords:
robot-assisted surgery, rectal cancer, sigmoid colon cancerAbstract
Introduction: Distal sigmoid and rectal carcinomas (DSaRCs) are a special entity among colorectal neoplasms due to some specific and typical features: (1) anatomical—lower abdominal and pelvic location; (2) tumor aggressive biology—invasiveness and metastatic routes; (3) results—relatively higher rates of anastomotic leakage and recurrence. Robot-assisted surgery (RAS) in DSaRC makes some of the procedure steps easier, safer, and oncologically more radical.
Aim: The aim of this article is to present a single-institution, single-team experience with RAS for DSaRC with a focus on some personal decisions on debatable problems.
Material and methods: We analyzed retrospectively a series of 343 RASs, all registered in My Intuitive. Distal sigmoid and rectal carcinomas accounted for 60% (n = 207) of those procedures, including 45% (Group 1, n = 155) low rectal resections (LRRs) and 15% (Group 2, n = 52) sigmoid colon resections (SCRs). The main study key points included surgical details: adhesions after previous surgeries; tumor location and T and N stages; conversion rate; dissection approach—lateral-to-medial or medial-to-lateral; vascular approach—high or selective ligation of inferior mesenteric vessels; protective ileostomy. Some early and late postoperative results were also analyzed—mortality, specific morbidity (anastomotic leakage), recurrence rate.
Results: Conversion rates in LRRs and SCRs were 1.9% in both groups (n = 3/155 and n = 1/52, respectively). Stage T4b was the only conversion indication. The lateral-to-medial approach first and the selective vascular ligation with station 253 lymph node dissection were preferred in all but 3 cases (1.4%). No early postoperative mortality was registered. Anastomotic leakage after LRR necessitated reoperation and ileostomy in 3 cases (1.9%). Recurrent disease was diagnosed in 4 patients after LRR (2.6%), between 6 and 14 months after the initial procedure.
Conclusions: Robot-assisted surgery in DSaRCs is a more effective alternative to open and laparoscopic surgery. Based on our personal experience, we may conclude that the advantages of robotic technique guarantee more precise actions during dissection, allow less traumatic but reasonably aggressive approaches and lead to better early and similar late results.
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