Hybrid Robotic Technique for Rectal Cancer: Low Anterior Resection and Perineal Resection

Abstract

Colorectal cancer is the third most commonly diagnosed cancer with over 1.4 million new cases each year [1]. As surgical technology has evolved so has the treatment for this disease. Rectal cancer resection is complicated by the anatomic configuration of the pelvis and the proximity of these tumors to the anus. Evolving optics have allowed for the increased use of laparoscopy to allow for better visualization during pelvic surgery however its use was not implemented initially. Both the technical challenge of laparoscopic rectal surgery and the concern over oncological outcome have made its widespread adoption limited. As more surgeons gain comfort with advanced laparoscopic techniques the only concern is of the oncologic benefit [2, 3, 4]. The Conventional vs. Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial examined oncologic outcomes between laparoscopic and open rectal resections. Laparoscopic resection was associated with a higher rate of positive circumferential margin; however this did not translate into an increase in local recurrence when compared to the open procedures [5]. Long-term follow-up from the CLASICC trial has continued to provide support for the safe use of laparoscopy in colon and rectal cancer. The overall survival at 5 years after a low anterior resection was 56.7% in the open group and 62.8% in the laparoscopic one; abdominal perineal resection showed similar results with an overall survival of 41.8% in open cases and 53.2% in laparoscopic cases [6]. The Colorectal cancer Laparoscopic or Open Resection (COLOR II) trial has also advanced the use of laparoscopy and helped to show similarity in the completeness of mesorectal resection with a 10% rate of positive circumferential resection margin independent of the technique when specimens from patients randomly assigned to laparoscopy or open resection were analyzed [7].