Short-term Outcome of Robotic Surgery for Mid Or Lower Retal Cancer After Preoperative Chemoradiotherapy

Yong Sok Kim, MD, Sung Chan Park, MD, Ji Won Park, MD, Dae Kyung Sohn, MD, Jae Hwan Oh, MD. Center for Colorectal Cancer, National Cancer Center, Goyang, South Korea

Purpose: The short-term outcome of robotic surgery for mid or lower rectal cancer after preoperative chemoradiotherapy has not been well reported. The aim of this study was to evaluate the safety and feasibility of robot-assisted total mesorectal excision after preoperative chemoradiotherapy.

Methods: From March 2010 to July 2011, twenty-six patients with cT3N0–2 mid or lower rectal cancer without distant metastasis underwent robot-assisted total mesorectal excision after preoperative chemoradiotherapy. Perioperative, pathologic, and postoperative outcomes were reviewed retrospectively.

Results: There were 16 (61.5%) men and 10 (38.5%) women, with a mean age of 54.6 years(range, 35-74). Mean BMI was 23.5±2.3kg/m² and mean distance from anal verge was 6.0±1.6cm. We performed 15 (57.7%) low anterior resections and 11(42.3%) ultralow anterior resections with double stapling or with coloanal anastomosis. A protecting ileostomy was performed for all the patients. There were four cases of conversion to laparoscopic surgery (15.4 %). Mean anesthesia time was 507minutes (range, 365–685) and the mean console time was 251minutes (range, 115-414). The mean blood loss was 217.3±149.0mL. There were no intraoperative complications in this series. The mean lymph node harvested was 21.2±9.5 and the circumferential resection margin was positive in one patient (3.8 %). According to the quality of total mesorectal excision, fifteen patients (57.7%) were complete, 10 patients (38.5%) nearly complete and one patient incomplete. The mean time of first flatus was 1.9±1.1 days and mean length of stay was 10.0±3.2days. Postoperative complications included 12 patients (46.2%). One patient required reoperation because of anastomosis disruption. There was no postoperative mortality.

Conclusion: Our preliminary results suggest that robot-assisted total mesorectal excision for mid or lower rectal cancer after preoperative chemoradiotherapy is a safe and feasible technique.

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