Abstract
Background: Curative resection of sigmoid colon and rectal cancer includes “high tie” of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the complication rate. We present preliminary experiences of operative and oncologic outcomes of patients with rectal or sigmoid colon cancer who underwent robotic surgery employing the high dissection and selective ligation technique.Methods: Over May 2013 to April 2017, 113 stage I–III rectal or sigmoid colon cancer patients underwent robotic surgery with the single-docking technique at one institution. We performed D3 lymph node dissection and low-tie ligation of the IMA (i.e., high dissection and selective ligation technique). Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method.Results: Sphincter preservation rate was 96.3% in rectal cancer patients. Median number of harvested lymph nodes was 12. Apical nodes were pathologically harvested in 84 (82.4%) patients. R0 resection was performed in 108 (95.6%) patients. Overall complication rate was 17.7%; but most complications were mild and the patients recovered uneventfully. Estimated 5-year OS was 86.1% and 3-year DFS was 79.6% after median follow-up periods of 49.1 months (range, 5.3–85.3).Conclusions: High dissection of the IMA and selective ligation of the major feeding vessel to the sigmoid colon or rectum can be safely performed using da Vinci Surgical System,yielding favorable clinical, and oncologic outcomes in rectal or sigmoid colon cancer treatment.
Highlights
Total mesorectal excision (TME) surgery, notably improves the clinical outcomes, has served as the essential procedure for patients with rectal cancer since it was first described by Heald and Ryall in 1982 [1]
Even in patients of locally advanced rectal cancer (LARC) or mid to low rectal cancer received concurrent chemoradiotherapy (CCRT), robotic rectal surgery is still associated with at least comparable short-term surgical outcomes [16,17,18]
Patients with stage I–III rectal or sigmoid colon cancer underwent robotic surgery with the single-docking technique were enrolled into this study
Summary
Total mesorectal excision (TME) surgery, notably improves the clinical outcomes, has served as the essential procedure for patients with rectal cancer since it was first described by Heald and Ryall in 1982 [1]. MacFarlane et al [2] reported a 5-year local recurrence rate of 5% in patients who underwent TME surgery alone. Robotics rectal cancer surgery is more favorable in regarding to clinical and short-term oncological outcomes and is suggested in several studies [12,13,14,15]. Even in patients of LARC or mid to low rectal cancer received CCRT, robotic rectal surgery is still associated with at least comparable short-term surgical outcomes [16,17,18]. We present preliminary experiences of operative and oncologic outcomes of patients with rectal or sigmoid colon cancer who underwent robotic surgery employing the high dissection and selective ligation technique
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