Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases
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ORIGINAL ARTICLE
Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases C. Ramachandra 1 & Pavan Sugoor 1 Vijay Patil 1
&
Uday Karjol 1 & Ravi Arjunan 1 & Syed Altaf 1 & C. Srinivas 1 & B. V. Prakash 1 &
Received: 20 May 2020 / Accepted: 3 September 2020 # The Author(s) 2020
Abstract Emerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/ 178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon. Keywords Rectal cancer . Robotic rectal resection . Robotic total mesorectal excision . Da Vinci surgical system
Introduction Neoadjuvant chemoradiotherapy (NACRT) has a major role in the treatment of locally advanced rectal tumours [1]. Oncological outcomes have improved following widespread acceptance of the principles of TME [2]. Surgical techniques govern oncological outcomes in rectal cancer surgery. Tumour-specific mesorectal excision or total mesorectal excision (TME) and achieving a negative circumferential resection margin (CRM) are associated with lower recurrence rates and improved overall survival [3–9]. * Pavan Sugoor [email protected] 1
Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
There have been numerous prospecti
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