Abstract
BackgroundColorectal cancer resection surgery with transvaginal specimen extraction is becoming increasingly accepted and used by surgeons. However, few publications on robotic anterior sigmoid colon and rectal cancer resection with transvaginal specimen extraction (TVSE) have been reported, and a clinical outcome comparison between conventional robotic minilaparotomy (LAP) and transvaginal specimen extraction in anterior sigmoid colon and rectal cancer resection has not been performed. The current study compared the short- and long-term outcomes of TVSE and LAP for sigmoid colon cancer and rectal cancer in a mono-institution.MethodsFrom December 2014 to October 2018, 45 patients who underwent TVSE and 45 patients who underwent LAP matched by tumor location, tumor stage, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, gender, and age at the same period were included in the current study. The short- and long-term outcomes of TVSE and LAP were discussed.ResultsNo significant differences were found in patient characteristics. For the short-term outcomes, the operative time in the TVSE group was longer than that in the LAP group, and the postoperative pain and additional analgesia were lower in the TVSE group. Patients in the TVSE group required slightly less time to pass first flatus. There were no significant differences in overall complications, time to regular diet, length of hospital stay after surgery, estimated blood loss, or pathological outcomes. For long-term outcomes, the 3-year overall survival (94.9% vs. 91.7%, p = 0.702) and 3-year disease-free survival (88.4% vs. 86.2%, p = 0.758) were comparable between the two groups.ConclusionThe robotic TVSE is safe and feasible in selected sigmoid/upper rectal cancer patients with tumor diameter < 5 cm. This approach has slightly better short-term outcomes in terms of less postoperative pain and less analgesic requirements without any significant difference in long-term outcomes.
Highlights
Colorectal cancer is the fifth most commonly diagnosed cancer and the fifth leading cause of cancer death
No significant differences were detected between the transvaginal specimen extraction (TVSE) and LAP groups in age, body mass index (BMI), clinical tumor location, American Society of Anesthesiologists (ASA) score, tumor location, previous abdominal surgery, or postoperative chemotherapy
The postoperative pain on day 1 after surgery was lower in the TVSE group than the LAP group
Summary
Colorectal cancer is the fifth most commonly diagnosed cancer and the fifth leading cause of cancer death. Current robotic techniques require an abdominal incision for reconstruction of the digestive tract and removal of the surgical specimen. Few publications have reported the clinical outcomes of robotic anterior resection with transvaginal NOSE for sigmoid colon cancer or rectal cancer, and no study has compared the shortand long-term outcomes with a conventional robotic procedure [16]. Transvaginal specimen extraction has been used in robotic anterior resection for sigmoid colon cancer and rectal cancer in our institution since 2014. We performed the present study of 90 patients to compare the short- and long-term outcomes of TVSE and LAP for sigmoid colon cancer and rectal cancer. The current study compared the short- and long-term outcomes of TVSE and LAP for sigmoid colon cancer and rectal cancer in a mono-institution
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