Robotic multi-visceral resection for locally-advanced rectal cancer: initial experiences

Abstract

Author(s): Muhammad Shamim, Ravish Jootun, Patricia Tejedor, Samuel Stefan, Ioannis Mykoniaths, Syed Naqvi, Jim Khan

Background: Locally advanced rectal cancers (10%-20%) can present with infiltration into adjacent viscera. R0 resections remain the key factor for better survival. Traditionally these cases have been managed with open surgery. There are some limitations of laparoscopic surgery in these cases, which can potentially be overcome by robotic surgery.

Objectives: To determine the feasibility and outcome results of robotic multi-visceral resection of stage T4 rectal carcinoma.

Methods: Consecutive patients having locally advanced carcinoma of rectum, which undergone robotic multi-visceral resections as the primary treatment between 2015-2018 were included, through our database which was maintained prospectively. All perioperative and intraoperative parameters were analyzed. Patient demographics, co-morbidities, preoperative imaging, endoscopic findings, operative data, histopathology results, postoperative hospital course and procedure related postoperative adverse events were noted and analyzed.

Results: 21 patients with the diagnosis of non-metastatic locally advanced rectal cancers were operated with Robotic Si/X platform. The median body mass index was 28.5 kg/m² (range 21-42). The mean blood loss during operation was 20 ml (range 5-200), and the mean duration of surgery was 280 min (range 240-430). The median hospital stay after operation was 6 days (range 4 days-25 days). On postoperative histopathology, R0 Resection rate was 90.5% (19/21).

Conclusions: The robotic multi-visceral en-bloc resection of stage T4 rectal carcinoma is technically feasible and oncologically safe. Advanced technical skills, accurate radiological staging and careful patient selection can allow the extension of minimal access surgery to this challenging group of patients.

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