ABSTRACT
BACKGROUND: Conventional laparoscopy has been applied to colorectal resections for more than 2 decades. However, laparoscopic rectal resection is technically demanding, especially when performing a tumor-specific mesorectal excision in a difficult pelvis. Robotic surgery is uniquely designed to overcome most of these technical limitations. The aim of this study was to confirm the feasibility of robotic rectal cancer surgery in a large multicenter study. METHODS: Retrospective data of 425 patients who underwent robotic tumor-specific mesorectal excision for rectal lesions at seven institutions were collected. Outcome data were analyzed for the overall cohort and were stratified according to obese versus non-obese and low versus ultra-low resection patients. RESULTS: Mean age was 60.9 years, and 57.9 % of patients were male. Overall, 51.3 % of patients underwent neoadjuvant therapy, while operative time was 240 min, mean blood loss 119 ml, and intraoperative complication rate 4.5 %. Mean number of lymph nodes was 17.4, with a positive circumferential margin rate of 0.9 %. Conversion rate to open was 5.9 %, anastomotic leak rate was 8.7 %, with a mean length of stay of 5.7 days. Operative times were significantly longer and re-admission rate higher for the obese population, with all other parameters comparable. Ultra-low resections also had longer operative times. CONCLUSION: Robotic-assisted minimally invasive surgery for the treatment of rectal cancer is safe and can be performed according to current oncologic principles. BMI seems to play a minor role in influencing outcomes. Thus, robotics might be an excellent treatment option for the challenging patient undergoing resection for rectal cancer.
Subject(s)
Adenocarcinoma/surgery , Digestive System Surgical Procedures , Minimally Invasive Surgical Procedures , Postoperative Complications , Rectal Neoplasms/surgery , Robotic Surgical Procedures , Adenocarcinoma/pathology , Feasibility Studies , Female , Follow-Up Studies , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Neoplasm Staging , Prognosis , Rectal Neoplasms/pathology , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
Pelvic surgery for malignant disease has been associated with numerous acute postoperative complications. These complications are primarily vascular or neurologic in origin. Several factors associated with the occurrence of these complications include the lithotomy position, the prolonged use of sequential compression devices, the use of certain types of stirrups, the presence of peripheral vascular disease, and the common hypercoagulable state of most cancer patients. We report for the first time a case of aortic thrombosis after elective low anterior resection for rectal cancer and discuss some factors that may have a role in the occurrence of this devastating complication.
