Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center
Tóm tắt
The safety and feasibility of robotic-assisted multivisceral resection for locally advanced rectal cancer remain unclear. The aim of this study was to assess the short-term outcomes of this procedure at our institution. From December 2011 to December 2016, patients who underwent robotic-assisted multivisceral resection for rectal cancer were investigated. Patient demographics, treatment characteristics, perioperative outcomes, and pathological results were evaluated retrospectively. There were 31 patients; 17 men (54.8%) and 14 women (45.2%), with a median age of 65 years (range 40–82 years). Twenty-one patients (67.7%) had a cT4 tumor, 9 patients (29.0%) had a pT4b tumor, and all patients except one (96.8%) underwent complete resection of the primary tumor with negative resection margins. Eleven patients (35.5%) received neoadjuvant chemoradiation. The most commonly resected organ was the vaginal wall (n = 12, 38.7%), followed by the prostate (n = 10, 32.3%). Lateral lymph node dissection was performed in 20 patients (64.5%). The median operative time was 394 min (range 189–549 min), and the median blood loss was 41 mL (range 0–502 mL). None of the patients received intraoperative blood transfusions or required conversion to open. Overall, postoperative complications occurred in 11 patients (35.5%). The most frequent complication was urinary retention (n = 5, 16.1%), and none of the patients developed serious complications classified as Clavien–Dindo grades III–V.
Robotic-assisted multivisceral resection for rectal cancer is safe and technically feasible.
Tài liệu tham khảo
Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52. https://doi.org/10.1016/s1470-2045(08)70310-3
Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662. https://doi.org/10.1097/SLA.0b013e318155a762 (discussion 662-654)
van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218. https://doi.org/10.1016/s1470-2045(13)70016-0
Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332. https://doi.org/10.1056/NEJMoa1414882
Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645. https://doi.org/10.1016/s1470-2045(10)70131-5
Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774. https://doi.org/10.1016/s1470-2045(14)70205-0
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645. https://doi.org/10.1002/bjs.7160
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616
Akiyoshi T (2016) Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer. World J Gastroenterol 22:718–726. https://doi.org/10.3748/wjg.v22.i2.718
Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H, Yamakawa Y (2016) Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center. Surg Today 46:957–962. https://doi.org/10.1007/s00595-015-1266-4
Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H (2016) Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 30:721–728. https://doi.org/10.1007/s00464-015-4266-y
Sun Y, Xu H, Li Z et al (2016) Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol 14:61. https://doi.org/10.1186/s12957-016-0816-6
Wang Y, Zhao GH, Yang H, Lin J (2016) A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutan Tech 26:259–264. https://doi.org/10.1097/sle.0000000000000263
Shin US, Nancy You Y, Nguyen AT et al (2016) Oncologic outcomes of extended robotic resection for rectal cancer. Ann Surg Oncol 23:2249–2257. https://doi.org/10.1245/s10434-016-5117-3
Shin JW, Kim J, Kwak JM et al (2014) First report: robotic pelvic exenteration for locally advanced rectal cancer. Colorectal Dis 16:O9–14. https://doi.org/10.1111/codi.12446
Watanabe T, Itabashi M, Shimada Y et al (2015) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20:207–239. https://doi.org/10.1007/s10147-015-0801-z
Kagawa H, Kinugasa Y, Shiomi A et al (2015) Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surg Endosc 29:995–1000. https://doi.org/10.1007/s00464-014-3760-y
International Union against C, Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumours, 7th edn. Wiley, New York
Akiyoshi T, Watanabe T, Miyata S et al (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255:1129–1134. https://doi.org/10.1097/SLA.0b013e3182565d9d
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H (2014) Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Colorectal Dis 29:1105–1111. https://doi.org/10.1007/s00384-014-1921-z
Heslov SF, Frost DB (1988) Extended resection for primary colorectal carcinoma involving adjacent organs or structures. Cancer 62:1637–1640
Stevenson AR, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363. https://doi.org/10.1001/jama.2015.12009
de’Angelis N, Landi F, Vitali GC et al (2016) Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-016-5332-9
Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13:138–143. https://doi.org/10.1111/j.1463-1318.2010.02380.x
Zerey M, Hawver LM, Awad Z et al (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27:1–10. https://doi.org/10.1007/s00464-012-2592-x
Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C (2002) Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 235:217–225
Manas MJ, Espin E, Lopez-Cano M, Vallribera F, Armengol-Carrasco M (2015) Multivisceral resection for locally advanced rectal cancer: prognostic factors influencing outcome. Scand J Surg 104:154–160. https://doi.org/10.1177/1457496914552341
Smith JD, Nash GM, Weiser MR, Temple LK, Guillem JG, Paty PB (2012) Multivisceral resections for rectal cancer. Br J Surg 99:1137–1143. https://doi.org/10.1002/bjs.8820
Kim KY, Hwang DW, Park YK, Lee HS (2012) A single surgeon’s experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely? Surg Endosc 26:493–500. https://doi.org/10.1007/s00464-011-1907-7
Nagasue Y, Akiyoshi T, Ueno M et al (2013) Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes. J Gastrointest Surg 17:1299–1305. https://doi.org/10.1007/s11605-013-2222-5
Yamaguchi T, Kinugasa Y, Shiomi A et al (2015) Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29:1679–1685. https://doi.org/10.1007/s00464-014-3855-5
Park EJ, Cho MS, Baek SJ et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137. https://doi.org/10.1097/sla.0000000000000613
Winters BR, Mann GN, Louie O, Wright JL (2015) Robotic total pelvic exenteration with laparoscopic rectus flap: initial experience. Case Rep Surg 2015:835425. https://doi.org/10.1155/2015/835425