Alessandra Marano, Maria Carmela Giuffrida, Luca Pellegrino, Gaspare Cannata, Diego Sasia, Danilo Donati, Felice Borghi. Santa Croce e Carle Hospital
INTRODUCTION: Rectal cancer continues to be a surgical challenge. New technologies must be incorporated into practice and, at the same time, oncologic surgery and overall outcomes must be improved. The use of da Vinci robotic surgery systems has spread rapidly in the field of rectal cancer treatment showing several technical advantages and favorable outcome compared to laparoscopy. Since the introduction of the robotic platform in our Institution in 2013, we have adopted a single-docking robotic technique for rectal resection. The aim of this study is to present our standardized technique and to analyse the clinical outcomes of the first 100 robotic rectal procedures.
METHODS AND PROCEDURES: Prospectively collected data reviewed from 100 consecutive patients who underwent single docking totally robotic (da Vinci® Si™) dissection for rectal cancer resection between June 2013 and August 2017 under ERAS program. Robotic rectal surgery was performed without changing the position of the robotic cart but only the robotic arms are repositioned between two phases: 1) vascular ligation, and sigmoid colon to splenic flexure mobilization; and 2) pelvic TME.
RESULTS: There were 66 men (66%) and the median age was 68 years (range-24–92). Thirty-five patients had neo-adjuvant chemoradiotherapy whilst 15 patients had BMI >30. Procedures performed included anterior resection (n = 95) and abdominoperineal resection (n = 5). Protective ileostomy was performed in 50 patients. The median operating time was 270 min (range-160–604). There was one conversion and two intra-operative complications (one bladder lesion and one ureteral lesion, respectively). Median length of stay was 3.5 days (range, 3–42), and readmission rate was 7%. Thirty-day mortality was zero. Anastomotic leak rate was 7%, and all patients except by one were managed conservatively. The mean lymph node harvested was 14 (SD+/− 8.3). Radial margin was negative in all patients. At median follow-up of 21 months, there were no local recurrences.
CONCLUSION(S): The single docking robotic technique is a safe and feasible approach for rectal surgery: in our study it has demonstrated favourable clinical outcomes and the adoption of a standardized stepwise approach was useful especially during the initial learning phase. To the best of our knowledge, this is the largest series from Italy to report this standardized approach and the short-term clinical and oncological outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87371
Program Number: P803
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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