Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases

C Ramachandra,Pavan Sugoor,Syed Altaf,B V Prakash,Uday Karjol,Vijay Patil,Ravi Arjunan,C Srinivas

doi:10.1007/s13193-020-01212-5

Abstract

Emerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon.

Highlights

Neoadjuvant chemoradiotherapy (NACRT) has a major role in the treatment of locally advanced rectal tumours [1]
Few studies have raised concerns on the quality of TME, composite pathological outcomes, and the oncological safety associated with the laparoscopic total mesorectal excision (L-TME approach) [15,16,17]
NACRT was offered to patients with clinical stage T3–T4 N0 or any T N+ with or without mesorectal fascia (MRF) involvement

Summary

Introduction

Neoadjuvant chemoradiotherapy (NACRT) has a major role in the treatment of locally advanced rectal tumours [1]. Surgical techniques govern oncological outcomes in rectal cancer surgery. Tumour-specific mesorectal excision or total mesorectal excision (TME) and achieving a negative circumferential resection margin (CRM) are associated with lower recurrence rates and improved overall survival [3,4,5,6,7,8,9]. There have been numerous prospective randomized studies about the superior short-term outcomes of laparoscopic surgery for rectal cancer in comparison with open rectal resections [10,11,12,13,14]. Few studies have raised concerns on the quality of TME, composite pathological outcomes, and the oncological safety associated with the laparoscopic total mesorectal excision (L-TME approach) [15,16,17]. The question remains still open after the publication of the results of the latest trials [17,18,19,20]

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Discussion

Conclusion