Takuya Miura, Yoshiyuki Sakamoto, Hajime Morohashi, Hayato Nagase, Tatsuya Yoshida, Kentaro Sato, Yutaro Hara, Kenichi Hakamada. Hirosaki university
Background/Aim: Laparoscopic-Intersphincteric resection (ISR) and Low anterior resection (LAR) for rectal cancer is widely accepted, but the usefulness and problems of TaTME and Robot remained unclear. By comparing with Lap, we will examine the current status of TaTME-ISR and Robot-LAR.
Methods: We compared 13 patients of Lap-ISR+diverting stoma (DS) with 15 patients of TaTME-ISR+DS and 19 patients of Lap-LAR+DS with 7 patients of robot-LAR+DS retrospectively. In our hospital, TaTME was only introduced to ISR. LLND cases were excluded in the comparison between Robot and Lap, because Robot-lateral lymph node dissection (LLND) was only performed in one patient. The patients who underwent a partial resection of adjacent organs, pelvic exenteration, and simultaneous resection other than pelvic organs were excluded.
Results:
1. Lap vs TaTME-ISR. In the characteristics, distance from tumor margin to anal verge was statistically longer in TaTME (3cm/5cm) but gender (male, 69%/82%), BMI (22.8/22.4), preoperative chemotherapy (23%/46%), tumor diameter (3cm/4cm), T3 (15%/21%), lymph node metastasis (7%/6%) and lateral lymph node dissection (61%/46%) were not obviously different. Postoperative complications in Lap were 15% of anastomotic leakage (Grade A 1, B 1), 15% of intracorporeal SSI, 15% of stoma related complications and 7% of urinary retention (Grade 2). TaTME had 20% of anastomotic leakage (GradeA 1, B 2), 53% of intracorporeal SSI, 46% of stoma related complications and 6% of urinary retention (Grade 1). The definitive stoma was created in 7% after Lap-ISR and 33% after TaTME.
2. Lap-LAR vs Robot-LAR. In the characteristics, Lap group had more advanced tumor such as size (15mm/35mm), T3 (52%/14%), and lymph node metastasis (42%/0%). Gender (male, 100%/100%), BMI (22.5/24.0), preoperative chemotherapy (5%/0%), and distance from tumor margin to anal verge (9cm/7cm) were not obviously different. Operative time was longer in Robot (260min/404min) but blood loss was not different (15ml/20ml). Postoperative complications in Lap-LAR were 31% of anastomotic leakage (Grade A 1, B 3, C 2), 21% of stoma related complications and 5% of urinary retention (Grade 2). Robot-LAR had 0% of anastomotic leakage, 28% of stoma related complications and 14% of urinary retention (Grade 1).
Conclusions: Compared to Lap-ISR, TaTME-ISR in the early stage of introduction had many intracorporeal SSI, stoma-related complications and definitive stoma. Robot-LAR can reduce anastomotic insufficiency as compared with Lap-LAR.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92346
Program Number: P290
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster