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Erschienen in: Annals of Surgical Oncology 11/2007

01.11.2007 | Gastrointestinal Oncology

Short-Term Outcomes After Robotic-Assisted Total Mesorectal Excision for Rectal Cancer

verfasst von: Minia Hellan, MD, Casandra Anderson, MD, Joshua D. I. Ellenhorn, MD, Benjamin Paz, MD, FACS, Alessio Pigazzi, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2007

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Abstract

Background

Laparoscopic total mesorectal excision for rectal cancer remains a difficult procedure with high conversion rates. We have sought to improve on some of the pitfalls of laparoscopy by using the DaVinci robotic system. Here we report our two-year experience with robotic-assisted laparoscopic surgery for primary rectal cancer.

Methods

A prospectively maintained database of all rectal cancer cases starting in November 2004 was created. A series of 39 consecutive unselected patients with primary rectal cancer was analyzed. Clinical and pathologic outcomes were reviewed retrospectively.

Results

22 patients had low anterior, 11 intersphincteric and six abdominoperineal resections. Postoperative mortality and morbidity were % and 12.8%, respectively. The median operative time was 285 minutes (range 180–540 mins). The conversion rate was 2.6%. A total mesorectal excision with negative circumferential and distal margins was accomplished in all patients, and a median of 13 (range 7–28) lymph nodes was removed. The anastomotic leak rate was 12.1%. The median hospital stay was 4 days. There have been no local recurrences at a median follow-up of 13 months.

Conclusions

Robotic-assisted surgery for rectal cancer can be carried out safely and according to oncological principles. This approach shows promising short-term outcomes and may facilitate the adoption of minimally invasive rectal surgery.
Literatur
1.
Zurück zum Zitat Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon cancer. Consensus of the European Association of Endoscopic Surgery (E.A.E.S). Surg Endosc 2004; 18:1163–85PubMedCrossRef Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon cancer. Consensus of the European Association of Endoscopic Surgery (E.A.E.S). Surg Endosc 2004; 18:1163–85PubMedCrossRef
2.
Zurück zum Zitat The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050–9CrossRef The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050–9CrossRef
3.
Zurück zum Zitat Guillou PJ, Quirke P, Thorpe H, et al. MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 2005; 365:1718–26PubMedCrossRef Guillou PJ, Quirke P, Thorpe H, et al. MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 2005; 365:1718–26PubMedCrossRef
4.
Zurück zum Zitat Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004; 363:1187–92PubMedCrossRef Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004; 363:1187–92PubMedCrossRef
5.
Zurück zum Zitat Zhou ZG, Hu M, Li Y, et al. Laparoscopic vs. open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 2004; 18:1211–5PubMedCrossRef Zhou ZG, Hu M, Li Y, et al. Laparoscopic vs. open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 2004; 18:1211–5PubMedCrossRef
6.
Zurück zum Zitat Morino M, Parini U, Giraudo G, Salval M, Contul RB, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003; 237:335–42PubMedCrossRef Morino M, Parini U, Giraudo G, Salval M, Contul RB, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003; 237:335–42PubMedCrossRef
7.
Zurück zum Zitat Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2004; 18:281–9PubMedCrossRef Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2004; 18:281–9PubMedCrossRef
8.
Zurück zum Zitat Barlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 2005; 19:757–66PubMedCrossRef Barlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 2005; 19:757–66PubMedCrossRef
9.
Zurück zum Zitat Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR. Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 2001; 44:315–21PubMedCrossRef Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR. Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 2001; 44:315–21PubMedCrossRef
10.
Zurück zum Zitat Morino M, Allaix ME, Giraudo G, Corno F, Garrone C. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 2005; 19:1460–7PubMedCrossRef Morino M, Allaix ME, Giraudo G, Corno F, Garrone C. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 2005; 19:1460–7PubMedCrossRef
11.
Zurück zum Zitat Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 2006; 13:413–24PubMedCrossRef Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 2006; 13:413–24PubMedCrossRef
12.
Zurück zum Zitat Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 2005; 19:892–6PubMedCrossRef Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 2005; 19:892–6PubMedCrossRef
13.
Zurück zum Zitat Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg 2004; 239:14–21PubMedCrossRef Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg 2004; 239:14–21PubMedCrossRef
14.
Zurück zum Zitat Patel VR, Chammas MF Jr, Shah S. Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract 2007; 61:309–14PubMedCrossRef Patel VR, Chammas MF Jr, Shah S. Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs. Int J Clin Pract 2007; 61:309–14PubMedCrossRef
15.
Zurück zum Zitat Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 2006; 20:1521–5PubMedCrossRef Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 2006; 20:1521–5PubMedCrossRef
16.
Zurück zum Zitat Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133:894–9PubMedCrossRef Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133:894–9PubMedCrossRef
17.
Zurück zum Zitat Ballantyne GH, Moll F. The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. Surg Clin North Am 2003; 83:1293–1304PubMedCrossRef Ballantyne GH, Moll F. The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. Surg Clin North Am 2003; 83:1293–1304PubMedCrossRef
18.
19.
Zurück zum Zitat D’Annibale A, Morpurgo E, Fiscon V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 2004; 47:2162–8PubMedCrossRef D’Annibale A, Morpurgo E, Fiscon V, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 2004; 47:2162–8PubMedCrossRef
20.
Zurück zum Zitat Rockall TA, Darzi A. Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am 2003; 83:1463–8PubMedCrossRef Rockall TA, Darzi A. Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am 2003; 83:1463–8PubMedCrossRef
21.
Zurück zum Zitat Munz Y, Moorthy K, Kudchadkar R, et al. Robotic assisted rectopexy. Am J Surg 2004; 187:88–92PubMedCrossRef Munz Y, Moorthy K, Kudchadkar R, et al. Robotic assisted rectopexy. Am J Surg 2004; 187:88–92PubMedCrossRef
22.
Zurück zum Zitat Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 2006; 20:1713–8PubMedCrossRef Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 2006; 20:1713–8PubMedCrossRef
23.
Zurück zum Zitat Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003; 138:777–84PubMedCrossRef Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003; 138:777–84PubMedCrossRef
24.
Zurück zum Zitat Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003; 170:1738–41PubMedCrossRef Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003; 170:1738–41PubMedCrossRef
25.
Zurück zum Zitat Tsang WW, Chung CC, Kwog SY, Li MK. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 2006; 243:35–38CrossRef Tsang WW, Chung CC, Kwog SY, Li MK. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 2006; 243:35–38CrossRef
26.
Zurück zum Zitat Morgan BJ, Heald RJ. Risk factors for, and management of anastomotic leakage in rectal surgery. Colorectal Dis 2001; 3:135–7CrossRef Morgan BJ, Heald RJ. Risk factors for, and management of anastomotic leakage in rectal surgery. Colorectal Dis 2001; 3:135–7CrossRef
27.
Zurück zum Zitat Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998; 85:526–9PubMedCrossRef Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998; 85:526–9PubMedCrossRef
28.
Zurück zum Zitat Moloo H, Mamazza J, Poulin EC, et al. Laparoscopic resections for colorectal cancer: Does conversion affect survival? Surg Endosc 2004; 18:732–5PubMedCrossRef Moloo H, Mamazza J, Poulin EC, et al. Laparoscopic resections for colorectal cancer: Does conversion affect survival? Surg Endosc 2004; 18:732–5PubMedCrossRef
Metadaten
Titel
Short-Term Outcomes After Robotic-Assisted Total Mesorectal Excision for Rectal Cancer
verfasst von
Minia Hellan, MD
Casandra Anderson, MD
Joshua D. I. Ellenhorn, MD
Benjamin Paz, MD, FACS
Alessio Pigazzi, MD, PhD
Publikationsdatum
01.11.2007
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2007
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9544-z

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