Robotic beyond total mesorectal excision surgery for primary and recurrent pelvic malignancy: Feasibility and short‐term outcomes

Larach, José Tomás; Flynn, Julie; Fernando, Diharah; Mohan, Helen; Rajkomar, Amrish; Waters, Peadar S; Kong, Joseph; McCormick, Jacob; Heriot, Alexander G.; Warrier, Satish

doi:10.1111/codi.16136

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Recent literature has shown that robotic-assisted bTME procedures have acceptable shortterm safety (Clavien-Dindo > IIIa complication rate of 22.1%; R1 rate of 4.2%), early recovery and survival rates when performed at specialized centres. 22,23 The univariate analysis performed on the data in the current study demonstrated that minimally invasive procedures showed comparable or better DFS than reported for these previous studies (Table 4). However, this could be attributed to selection bias in view of the nature of procedures adopted in open surgery.…”

Section: Discussionsupporting

confidence: 67%

“…Although minimally invasive procedures were adopted in 51.3% of patients in the present study, some 87% were performed after 2018, with 7.5% of patients undergoing robotic surgery. Recent literature has shown that robotic‐assisted bTME procedures have acceptable short‐term safety (Clavien–Dindo > IIIa complication rate of 22.1%; R1 rate of 4.2%), early recovery and survival rates when performed at specialized centres 22, 23 4).…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer

et al. 2023

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Aim Extended total mesorectal excision (eTME) is a complex procedure involving en bloc resection of the structures surrounding the various quadrants of the rectum. This study, presenting the largest series so far of patients undergoing eTME, aimed to assess the surgical and survival outcomes of patients following treatment with eTME and to compare these outcomes with historical data on pelvic exenteration. Method The study is a retrospective review of all patients with locally advanced rectal cancer requiring an eTME (2014–2020). The database includes the demographic profile, operative details, histopathological features and follow‐up. Results One hundred and sixty three patients who underwent eTME were analysed. The overall Clavien–Dindo complication rate of > IIIa was 21.1%. The anterior quadrant was the most common anatomical site resected (68.5%). The R1 resection rate was 10.4%. After a median follow‐up of 28 months, there were 51 recurrences in the study and twenty two deaths were recorded. The local recurrence rate was 7.3% among the study population. The disease‐free survival (DFS) and overall survival were 66.7% and 80.4%, respectively, at 3 years. The majority of the recurrences were distant metastasis (84.3%). In univariate analysis, the quadrant involved did not affect survival. In multivariate analysis, signet ring histology, metastatic presentation, inadequate tumour response and R1 resection affected DFS. Conclusion The recurrence pattern, R1 resection rate and survival outcomes of patients in the present study were comparable with those for patients undergoing an exenteration. Therefore, eTME is probably a safe alternative to pelvic exenterations when R0 resection is achievable and when the procedure is performed in high‐volume specialist tertiary care centres.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer

et al. 2023

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“…24 The median LOS of 6 days seems to be within the range of previously reported studies, with mean 5 days found after robotic TME surgery, 25 while 12 to 16 days are reported in small series on complex robotic bTME surgery. 26,27 The LOS in a previously published cohort operated with open bTME surgery at our institution, was median 10 or 15 days depending on deep SSI or not. 28 Although the cohorts are not case-matched, one could speculate that robotic surgery reduce LOS for these patients.…”

Section: Discussionmentioning

confidence: 99%

Short-term results after robot-assisted surgery for primary rectal cancers requiring beyond total mesorectal excision in multiple compartments

Thorgersen,

Solbakken,

Strøm

et al. 2023

Scand J Surg

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Aim: Rectal cancers requiring beyond total mesorectal excision (bTME) are traditionally operated using an open approach, but the use of minimally invasive robot-assisted procedures is increasing. Introduction of minimal invasive surgery for complex cancer cases could be associated with compromised surgical margins or increased complication rates. Therefore, reporting results both clinical and oncological in large series is important. Since bTME procedure reports are heterogeneous, comparing results is often difficult. In this study, a magnetic resonance imaging (MRI) classification system was used to describe the bTME surgery according to pelvic compartments. Methods: Consecutive patients with primary rectal cancer operated with laparoscopic robot-assisted bTME were prospectively included for 2 years. All patients had tumors that threatened the mesorectal fascia, invaded adjacent organs, and/or involved metastatic pelvic lateral lymph nodes. Short-term clinical outcomes and oncological specimen quality were registered. Surgery was classified according to pelvic compartments resected. Results: Clear resection margins (R0 resection) were achieved in 95 out of 105 patients (90.5%). About 26% had Accordion Severity Grading System of Surgical Complications grade 3–4 complications and 15% required re-operations. About 7% were converted to open surgery. The number of compartments resected ranged from one to the maximum seven, with 83% having two or three compartments resected. All 10 R1 resections occurred in the lateral and posterior compartments. Conclusions: The short-term clinical outcomes and oncological specimen quality after robot-assisted bTME surgery were comparable to previously published open bTME surgery. The description of surgical procedures using the Royal Marsden MRI compartment classification was feasible.

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“…An increasing number of studies have shown that robotic radical resection of rectal cancer is safe and feasible, with good medium and long-term effects [ 8 , 9 ]. The results of this study showed that the average operation time of robotic rectal cancer radical surgery was 183.6 ± 44.8 min, the amount of intraoperative bleeding was 54.8 ± 34.4 ml, and the number of cleaned lymph nodes during surgery was 15.3 ± 7.8, which were consistent with the trend matching research results [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical efficacy and safety of hand-sewn anastomosis for the digestive tract with Da Vinci robot in rectal cancer surgery

Feng,

Sun,

Zhang

et al. 2023

World J Surg Onc

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Purpose The study aimed to analyze the clinical efficacy and safety of hand-sewn anastomosis for the digestive tract with Da Vinci robot in rectal cancer surgery. Methods A retrospective study was conducted to collect the clinical data from 27 patients who underwent Da Vinci robotic rectal cancer radical surgery in the department of gastrointestinal surgery at the Second Affiliated Hospital of Dalian Medical University from August 2019 to February 2022. All patients received a manual suture for digestive tract reconstruction. After the posterior wall was sutured, the anterior wall was sutured continuously. Finally, a prilling thread was used to sew the junction of the front and rear walls. Perioperative indexes and complications were recorded. Results All 27 patients successfully underwent the operation. Neither conversion to laparotomy nor perioperative death occurred. The operation time and intraoperative blood loss were 183.6 ± 44.8 min and 54.8 ± 34.4 ml, respectively. A total of 15.3 ± 7.8 lymph nodes were harvested. The pain score 24 h after operation was 1.3 ± 1.3. The time out of bed, the time to exhaust, and the time to eat were 15.6 ± 2.9 h, 2.2 ± 0.8 days, and 2.1 ± 0.6 days, respectively. A total of 4 patients (14.8%) developed complications after the operation. Grade B anastomotic leakage gradually resolved after drainage and antibiotic therapy in 1 case. A patient with grade C anastomotic leakage received a second operation for ileostomy. One patient with postoperative pneumonia recovered after anti-infective treatment. Another patient with intraperitoneal hemorrhage improved after symptomatic treatment with blood transfusion and hemostasis. The postoperative hospitalization time and total hospitalization costs were 8.9 ± 4.4 days and 89,236.1 ± 13,527.9 yuan, respectively. Conclusions Manual suture with Da Vinci robotic surgery system is safe and feasible for reconstructing the digestive tract in rectal cancer surgery.

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Robotic beyond total mesorectal excision surgery for primary and recurrent pelvic malignancy: Feasibility and short‐term outcomes

Cited by 9 publications

References 22 publications

Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer

Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer

Short-term results after robot-assisted surgery for primary rectal cancers requiring beyond total mesorectal excision in multiple compartments

Analysis of clinical efficacy and safety of hand-sewn anastomosis for the digestive tract with Da Vinci robot in rectal cancer surgery

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