Rectal Cancer Surgery Research Articles

Comparison of robotic assisted and laparoscopic radical resection for rectal cancer with or without left colic artery preservation.

The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p<0.001). The urinary catheter withdrawal time in the LL group was significantly shorter than that in the HL group (4.87 ± 2.04 d vs. 6.06 ± 2.43d, p<0.001). Anastomotic leakage in the LL group was significantly lower than that in HL group (1.44% vs. 7.91%, p = 0.011). The rate of urinary dysfunction and sexual dysfunction in LL group is both significantly lower than HL group. Blood loss and number of harvested lymph nodes (LNs) of both RAL subgroups in LL and HL groups were significantly more than that in LSC subgroups. The anastomotic leakage in the RAL subgroup of HL group was significantly lower than that in LSC subgroup (0% vs. 14.89%, p = 0.018). LCA preservation surgery for rectal cancer may help reduce the blood loss, urinary catheter withdrawal time, the rate of anastomotic leakage and ileus, and postoperative genitourinary function outcomes. RAL can reduce the probability of blood loss and improve harvest LNs in patients with rectal cancer.

Nomograms Predicting Survival, Recurrence and Beneficiary Identification of Adjuvant Chemotherapy in Treatment-naïve Patients with Rectal Cancer who Underwent Upfront Curative Resection: A multi-institutional study

Objective: To create and validate nomograms predicting overall survival and recurrence in treatment-naïve rectal cancer (RC) patients who underwent upfront surgery. Background: Although multidisciplinary treatment is standard for locally advanced RC, understanding surgical efficacy is important for determining indications for perioperative adjuvant therapy. Methods: RC patients who underwent upfront surgery at the Japanese Society for Cancer of the Colon and Rectum institutions were analyzed. A training cohort (n = 1925) of treatment-naïve patients who underwent surgery between 2007 and 2008 was analyzed to construct prognostic models predicting postoperative survival and recurrence. Discrimination and calibration were performed using an external validation cohort (n = 2957; Japanese colorectal cancer registry, procedures in 2005–2006). Effects of adjuvant chemotherapy on survival were evaluated based on nomogram prediction and Surveillance, Epidemiology, and End Results (SEER) data (n = 10,482; upfront surgery for RC in 2010–2015). Results: In the training cohort, age predicted survival, venous invasion predicted recurrence, and sex, tumor location, histological type, preoperative carcinoembryonic antigen, invasion depth, lymphatic invasion, positive radial margin, and numbers of metastatic nodes and examined nodes predicted both. Internal and external validated Harrell’s C-index values were respectively 0.77 and 0.75 for survival and 0.75 and 0.74 for recurrence. RC patients who underwent upfront surgery in the SEER database were stratified into 3 risk levels by nomogram score. Adjuvant chemotherapy did not improve 5-year survival in low-risk patients, but did so for middle-risk (62.4% vs 76.8%) and high-risk (39.4% vs 63.5%) patients. Conclusion: These nomograms could predict survival and recurrence after upfront curative resection of RC and identify cases expected to benefit more from adjuvant chemotherapy.

Utilizing C-Reactive Protein (CRP) and CRP Ratios for Early Detection of Postoperative Complications Following Rectal Cancer Surgery

Background: Surgical treatment for rectal cancer may cause complications that exacerbate the condition, lengthen hospital stays, and raise healthcare costs. Rectal cancer surgery complications can be detected immediately with postoperative C-reactive protein (CRP) monitoring. Elevated levels of CRP indicate the presence of inflammation and can serve as a predictive factor for future outcomes. Methods: A retrospective cohort analysis was performed on 67 rectal cancer surgery patients. Prior to and after surgery, CRP levels were measured on days 1–3 and 4–7. Postoperative complications were linked to CRP, surgical approach (open, laparoscopic, conversion), and patient characteristics. This study included t-tests, chi-square tests, Mann–Whitney U tests, ANOVA, Pearson and Spearman correlation analyses, and logistic regression. Results: There was a significant correlation between high levels of CRP on postoperative days 4–7 and the development of problems (p &lt; 0.001). The ratios of CRP/albumin and CRP/platelet were highly predictive of problems over this period (p = 0.000033). Patients who encountered problems had a notably greater estimated blood loss (p = 0.0086). Logistic regression analysis demonstrated a statistically significant relationship between higher Charlson Comorbidity Index (CCI) scores and an elevated probability of experiencing problems (p = 0.0078). Moreover, patients who underwent laparoscopic surgery but had to be converted to an open method saw a notably greater incidence of complications (p = 0.0022). From a financial standpoint, the average cost per patient with complications was EUR 1128.75, resulting in a total cost of EUR 44,021.25 for all 39 patients. Conversely, patients who did not experience any difficulties had a cost of EUR 731.25 per patient, resulting in a total of EUR 20,475.00 for all 28 patients. Conclusions: Regularly monitoring CRP, particularly between days 4 and 7 following surgery for rectal cancer, can promptly identify any complications. Monitoring CRP levels and promptly managing any abnormalities can enhance surgical outcomes and reduce healthcare costs.

Summary of Professor HUANG Jinchang's experience of electroacupuncture at Baliao acupoints for low anterior resection syndrome of rectal cancer

This paper introduces Professor HUANG Jinchang's experience in treating low anterior resection syndrome (LARS) of rectal cancer. Based on the clinical experience in treating fecal incontinence after rectal cancer surgery, Professor HUANG Jinchang proposes that the primary pathogenesis of LARS is spleen-kidney yang deficiency with internal obstruction of damp turbidity. The treatment approach should focus on strengthening the spleen, warming the kidney, and eliminating turbidity. The Baliao acupoints are specifically selected to eliminate turbidity, promote yang , facilitate the qi flow of the viscera, and regulate the opening and closing of the anus. Emphasis is placed on deep needling at the Baliao acupoints, with flexible acupoint selection based on accompanying symptoms. Additionally, moxibustion and bloodletting cupping are used to restore regular bowel movements and improve the quality of life for patients who have undergone anus-preserving surgery for rectal cancer.

Effect of left colonic artery preservation on perfusion at the anastomosis in rectal cancer surgery evaluated with intraoperative ultrasound.

Intraoperative ultrasound was used to assess the flow velocity in the marginal vessel arch adjacent to the anastomosis, critical for evaluating the anastomotic blood supply. This technique also enabled us to investigate the potential effects of preserving the left colonic artery on the perfusion of the anastomosis. This prospective study included 40 rectal cancer patients who underwent laparoscopic anterior resection between January 2021 and January 2023. The length of the inferior mesenteric artery (IMA) was measured from its origin to the first branch, and the diameters of the mesenteric vessel IMA, left colonic artery (LCA), and marginal mesenteric artery (MMA) were recorded. Blood flow velocity and Doppler ultrasound waveforms of the MMA near the anastomosis were collected. Measurements were taken both before and after clamping the IMA using atraumatic forceps. The tardus parvus pattern of the MMA ultrasound waveforms was recorded to evaluate the hypoperfusion status of the anastomosis. The mean velocities of MMA were 47.9cm/s before clamping and 34.9cm/s after atraumatic clamping, indicating significant differences (p < 0.05). Thirteen patients (32.5%) exhibited a Tardus parvus pattern after IMA atraumatic clamping. Multivariate analysis revealed older age and LCA diameter as independent clinical predictors of the hypoperfusion status after IMA clamping. Preservation of the LCA may improve perfusion near the anastomosis during rectal cancer surgery. Older age and LCA diameter can be considered useful predictors of the mesenteric hypoperfusion status after IMA ligation. Intraoperative ultrasound can evaluate the perfusion of the MMA near the anastomosis. Chinese Clinical Trial Registry-Registration number: ChiCTR2000041475.

Robotic surgery versus laparoscopic surgery for rectal cancer: a comparative study on surgical safety and functional outcomes.

This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)-assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation. Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot-assisted (n = 51) and laparoscopy-assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post-surgery. Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group. No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes.

Safety and feasibility of robotic surgery in geriatric patients with rectal cancer.

The incidence of rectal cancer is increasing in the elderly population, yet the safety of surgical interventions in this group, particularly robotic surgery, is still debated. This study aims to investigate the safety and short-term postoperative outcomes of robotic surgery in geriatric patients (aged ≥ 70years) with rectal cancer. Patients diagnosed with rectal cancer and undergoing robotic surgery between March 2021 and September 2023 were divided into two groups based on age: the elderly group (aged ≥ 70years) and the younger group (aged < 70years), totaling 108 patients. The study included 80 younger patients in group 1 and 28 elderly patients in group 2. The groups had similar gender distribution and tumor characteristics. The elderly group had higher ASA scores and lower albumin levels and underwent the Miles procedure more frequently. The stoma rate was higher in the elderly group. Operation duration, tumor diameter, lymph node dissection numbers, pathological stage, and other histopathological features were similar in the two groups. Postoperative outcomes like hospital stay, complication rates, anastomotic leakage, reoperation rates, unplanned readmissions, and mortality were comparable between the groups. Robotic surgery for rectal cancer in elderly patients is technically feasible and safe. Age should not be a determining factor in patient selection for robotic surgery or be considered a risk factor for postoperative complications.

Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR).

Compared to standardized minimally invasive colorectal procedures, there is considerable perioperative heterogeneity in loop ileostomy reversal. This study aimed to investigate the current perioperative practice and technical variations of loop ileostomy reversal following rectal cancer surgery. A nationwide online survey was conducted among members of the Italian Society of ColoRectal Surgery (SICCR). A link to the questionnaire was sent via mail. The survey consisted of 31 questions concerning the main procedural steps and application of the ERAS protocol after loop ileostomy reversal. Overall, 219 participants completed the survey. One respondent in four used a combination of water-soluble contrast studies (WSCS) and digital rectal examination to assess the integrity of the anastomosis before ileostomy closure. Conversely, 17.8% of them used either only WSCS or only endoscopy. Surgeons routinely perform hand-sewn or stapled anastomoses in 45.2% and 54.8% of the cases, respectively. Side-to-side antiperistaltic stapled anastomosis was the most performed anastomosis (36%). Most surgeons declared that they have never used prostheses for abdominal wall closure (64%), whereas 35% preferred retromuscular mesh placement in selected cases only. Forty-six respondents (66.7%) reported using interrupted stitches for skin closure, while 65 (29.7%) a purse-string suture. Furthermore, skin approximation at the stoma site using open methods was significantly more common among surgeons with greater experience in ileostomy reversal (p = 0.031). Overall, a good compliance with the ERAS protocol was found. However, colorectal surgeons were significantly more likely to follow the ERAS pathway than general surgeons (p < 0.05). Surgeons use different anastomotic techniques for ileostomy reversal after rectal cancer surgery. Based on current evidence, purse-string skin closure and ERAS pathway should be implemented, while the role of mesh prophylactic strategy needs to be explored further.

Truly Inevitable—Our Perspective on the Complications After Surgery for Rectal Cancer

Truly Inevitable—Our Perspective on the Complications After Surgery for Rectal Cancer

Effect of autonomic nervous system resection extent on urinary dysfunction in robotic rectal cancer surgery

AbstractAimWe investigated whether autonomic nervous system resection during robotic rectal surgery contributes to urinary dysfunction and to what extent.MethodsThis retrospective cohort study included patients who underwent rectal surgery for primary rectal cancer between December 2011 and April 2021. We identified urinary dysfunction risk factors and examined the effect of autonomic nervous system resection extent on urinary dysfunction occurrence, with urinary dysfunction defined as a residual urine volume of &gt;50 mL. Urinary dysfunction with no improvement over 1 y was defined as permanent urinary dysfunction.ResultsOf 1017 eligible patients, 78 (7.7%) required autonomic nervous system resection. Lateral lymph node dissection was performed in 357 patients (35.1%). Urinary dysfunction was observed in 102 patients (10.0%). We studied 32 (41.0%) of 78 patients who underwent autonomic nervous system resection and 82 (23.0%) of 357 patients who underwent lateral lymph node dissection presented with urinary dysfunction. Multivariate analysis revealed that lateral lymph node dissection and autonomic nervous system resection were significant predictors of urinary dysfunction. The urinary dysfunction incidence was notably higher in patients with autonomic nervous system unilateral total resection of at least one side than in those with bilateral preservation (65.4% vs. 28.8%, p &lt; 0.01), and permanent urinary dysfunction exclusively occurred in these patients.ConclusionIn robotic surgery, autonomic nervous system resection and lateral lymph node dissection were independent risk factors for urinary dysfunction. Furthermore, the extent of autonomic nervous system resection may increase the risk of permanent urinary dysfunction.

Influence of the rotation of the diverting loop ileostomy in rectal cancer surgery on small-bowel obstruction: A multicenter prospective study conducted by the Clinical Study Group of Osaka University, Colorectal Group

AimsWhether rotation of a diverting loop ileostomy during rectal cancer surgery, for reducing the catastrophic effect of an anastomotic leakage, affects the incidence of small-bowel obstruction has not been fully investigated. The purpose of this study is to explore whether technical maneuvers in diverting loop ileostomy creation, including its rotation, are associated with increased incidence of small-bowel obstruction in rectal tumor surgery. MethodsThis multicenter prospective study was conducted by the Clinical Study Group of Osaka University, which comprises 24 major institutions. Patients with rectal adenocarcinoma scheduled for laparoscopic/robotic low anterior resection or intersphincteric resection with a diverting loop ileostomy were included. A total of 451 patients were prospectively enrolled between July 2015 and April 2021. The primary endpoint was the relevance of loop ileostomy rotation to the incidence of small-bowel obstruction; the secondary endpoints included the origin of the small-bowel obstruction and length of hospital stay. ResultsSmall-bowel obstruction was observed in 10.8% in the nonrotated group and 12.3% in the rotated group, with no significant difference (P > .99). The only risk factor identified for small-bowel obstruction was distance from the ileocecal valve, with a significant difference in 16 patients (7.3%) with a distance of ≤30 cm and 16 patients (15.4%) in a distance of >30 cm (P = .028). ConclusionRotation of the diverting loop ileostomy had no significant effect on the incidence of small-bowel obstruction.

Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial

Laparoscopic surgery is increasingly used for rectal cancer, but the long-term oncological outcomes for low rectal cancer have not been fully established. We aimed to evaluate the 3-year survival outcomes of laparoscopic surgery versus open surgery in the treatment of low rectal cancer. This multicentre, randomised, controlled, non-inferiority trial was conducted at 22 tertiary hospitals in China. Individuals aged 18-75 years with histologically confirmed cT1-2N0, cT3-4aN0, or cT1-4aN1-2 rectal adenocarcinoma within 5 cm from the dentate line were eligible for inclusion. Participants were randomly assigned (2:1) to undergo laparoscopic surgery or open surgery. Central randomisation was conducted using a web response system, and was stratified by clinical stage, age, sex, BMI, and American Society of Anesthesiologists classification. Investigators, patients and statisticians were not masked to group allocation. The primary outcome was 3-year disease-free survival, defined as the time from the date of surgery to the date of locoregional recurrence, distant metastasis, or death from any cause, whichever occurred first. Non-inferiority was defined as a lower limit of one-sided 97·5% CI for group difference (laparoscopic surgery group minus open surgery group) of greater than -10%. The primary analyses were performed in the modified intention-to-treat population, which excluded patients with distant metastasis discovered during surgery and those who did not undergo surgery or underwent local resection only. The trial is registered with ClinicalTrials.gov, NCT01899547, and has been completed. Between Nov 12, 2013, and June 6, 2018, 1070 patients were enrolled and randomly assigned to treatment. 1039 patients (685 in the laparoscopic surgery group and 354 in the open surgery group; median age 57 years, IQR 50 to 64; 620 [60%] male and 419 [40%] women) were included in the modified intention-to-treat analysis. 3-year disease-free survival was 81·4% (95% CI 78·2 to 84·1) in the laparoscopic surgery group and 79·8% (75·2 to 83·6) in the open surgery group (hazard ratio [HR] 0·92, 95% CI 0·69 to 1·23; p=0·56). The difference between groups was 1·60% (one-sided 97·5% CI -3·34 to ∞, p<0·0001 for non-inferiority). 3-year overall survival was 91·7% (95% CI 89·3 to 93·5) in the laparoscopic surgery group and 93·7% (90·6 to 95·8) in the open surgery group (HR 1·34, 95% CI 0·82 to 2·19; p=0·24). 3-year locoregional recurrence was 3·7% (95% CI 2·5 to 5·3) and 2·3% (1·1 to 4·3), respectively (HR 1·64, 95% CI 0·74 to 3·63; p=0·22). 5-year overall survival was 84·6% (95% CI 81·5 to 87·1) and 86·6% (82·5 to 89·8) in the open group (HR 1·16, 95% CI 0·82 to 1·64; p=0·41). Laparoscopic surgery performed by experienced surgeons is non-inferior to open surgery for 3-year disease-free survival among patients with low rectal cancer. These results support the use of laparoscopic surgery for low rectal cancer. The Key Clinical Specialty Discipline Construction Program of the National Health and Family Planning Commission of China; Minimally Invasive Medical Center Construction Program, Fujian Province, China; and Joint Funds for the Innovation of Science and Technology, Fujian Province, China.

Short- and long-term outcomes of robotic and laparoscopic surgery in rectal cancer: a propensity score-matched analysis.

The relative benefits of robotic surgery and laparoscopic surgery are controversial in rectal cancer. This study compared the short- and long-term outcomes of robotic surgery with those of laparoscopic surgery in patients with rectal cancer using propensity score analysis. This study analyzed consecutive patients who underwent minimally invasive surgery for stage I-III rectal cancer between April 2014 and October 2020. After propensity score matching (PSM), short-term outcomes, relapse-free survival, and overall survival were compared between the robotic surgery (RS) group and the laparoscopic surgery (LS) group. During the study period, 251 patients underwent laparoscopic surgery and 193 underwent robotic surgery. PSM resulted in 160 matched pairs (After PSM, the percentages of patients with stage I, II, and III disease were respectively 56%, 19%, and 24% in the LS group and 49%, 23%, and 28% in the RS group (P = 0.462). Median operation time was 239min in the LS group and 284min in the RS group (P = 0.001). The C-reactive protein level on postoperative day 3 was significantly lower in the RS group (4.63mg/mL vs. 5.86mg/mL, P = 0.013). Postoperative complications, including ileus and Clavien-Dindo grade II or higher complications, were 6% vs. 1% (P = 0.006) and 21% vs. 12% (P = 0.024) in the LS and RS groups, respectively. The 5-year relapse-free survival rate was 88.5% in the LS group and 90.5% in the RS group (P = 0.525); the respective 5-year overall survival rates were 97.3 and 93.8% (P = 0.283). The 5-year cumulative local and distant recurrence rates were 3.3% vs. 3.3% (P = 0.665) and 9.7% vs. 7.7% (P = 0.464) in the LS and RS groups, respectively CONCLUSION: Robotic surgery can be a feasible treatment modality for rectal cancer, with lower frequencies of postoperative ileus and Clavien-Dindo grade II or higher complications than laparoscopic surgery and no difference in long-term outcomes.

057. The Comparative Efficacy of Robot-Assisted Versus Laparoscopic Surgery for Rectal Cancer: A Systematic Review and Meta-Analysis

Background: Background: Total mesorectal excision (TME) is the gold standard surgical intervention for rectal cancer, associated with effective local recurrence management and improved overall survival rates. Laparoscopic surgery for colon cancer is primarily recognised as a curative treatment. Nonetheless, laparoscopic surgery for rectal cancer presents technological limitations. Robot-assisted laparoscopic total mesorectal excision (TME) surgery for rectal cancer was established to address these technical difficulties. Our objective was to assess the clinical and oncological outcomes of robot-assisted surgery compared to laparoscopic surgery for rectal cancer. Methods: We searched PubMed, ScienceDirect, and CENTRAL to identify studies and trials published between 2014 and 2023. The outcomes of our study encompass operational duration, duration of hospital admission, and intra-operative haemorrhage. We employed Revman 5.4.2 to do the meta-analysis. Results: Seven trials were analysed, encompassing 1,231 patients, including 545 patients who underwent robotic-assisted surgery and 686 patients who received laparoscopic surgery. Our results demonstrate that robot-assisted surgery significantly reduced operation time (MD 74.04, 95% CI [28.12, 119.97], p = 0.002), hospital stay (MD -1.86, 95% CI [-2.68, -1.05], p &lt; 0.00001), and intra-operative blood loss (MD 36.83, 95% CI [23.55, 50.11], p &lt; 0.00001). Our study identified robot-assisted surgery as a viable option for rectal cancer treatment. Conclusion: Our study revealed that robot-assisted surgery correlated with decreased intra-operative blood loss, operative duration, and length of hospital stay. Further research is needed to corroborate these findings

Oncological safety of laparoscopic surgery for low rectal cancer

Oncological safety of laparoscopic surgery for low rectal cancer

The Effect of Multifaceted Anastomotic Leakage Prevention via ICG and SST for Lower Rectal Anastomosis.

In rectal cancer surgery, anastomotic leakage (AL) is the most important complication and has a reported frequency of 11-15%. The causes of AL leakage are complex, and AL prevention should be performed in multiple directions. Thus, this study examined the usefulness of the comprehensive and multifaceted AL preventive measures. In total, 164 rectal surgery patients who had low rectal staple anastomosis below the peritoneal reflection were enrolled. The patients were divided into two groups: (i) the multifaceted AL prevention group (MP group, n=34) and (ii) the insufficient AL prevention group (IP group, n=130). Multifaceted AL prevention was defined as intestinal blood flow evaluated via indocyanine green (ICG)-fluorescence imaging (FI), the use of a single-staple technique (SST) without intersecting stapling lines or "dog ears", the use of transanal suture reinforcement according to the air leakage test, and the use of a transanal tube for anatomical decompression and a diverting stoma for diverting the fecal stream. The AL rates were retrospectively compared between the two groups. The data are expressed as the median and interquartile range. The rate of AL was significantly lower in the MP group (0%) than in the IP group (11.54%) (p=0.0423). Multifaceted AL prevention, including ICG-FI and SST, achieved a zero incidence of AL. Multifaceted prevention significantly lessened AL more than inadequate prevention did. Therefore, if the weight of each preventive measure cannot be clearly identified, to avoid AL, it is important to take all preventive measures from multiple aspects.

Short-term outcomes of da Vinci SP versus Xi for rectal cancer surgery: a propensity score matching analysis of two tertiary center cohorts.

This study compares the perioperative outcomes of robotic rectal cancer surgery between da Vinci single-port (SP) system, the most recent system allowing minimally invasive surgery with reduced ports, and the da Vinci Xi system. Patients who underwent robotic surgery for rectal adenocarcinoma from January 2016 to September 2023 at two tertiary referral centers were included. A retrospective analysis was conducted to compare key parameters between patient cohorts before and after propensity score matching. A total of 378 patients (SP, 65 vs. Xi, 313) were analyzed. The SP group comprised a higher proportion of females (44.6% vs. 28.4%; p = 0.016) and a higher tumor location (8.25cm vs. 6.71cm from the anal verge; p < 0.001) than did the Xi group. SP surgery promoted a shorter total incision length (4.9 cm vs. 9.2 cm; p < 0.001), lower maximum pain scores (5 vs. 7; p < 0.001), and shorter hospital stay (6 vs. 7days; p < 0.001) than did Xi surgery. Operation time (175 vs. 182min; p = 0.829) and postoperative complications (9.2% vs. 12.1%; p = 0.650) did not significantly differ between the groups. Lower lying rectal tumors were more frequently treated using the Xi system than the SP system, promoting a higher diverting stoma rate (13.8% vs. 45.4%; p < 0.001) and a lower anastomosis level (4.6cm vs. 3.3cm; p < 0.001). After 1:1 matching, SP maintained its advantages over Xi in terms of incision length (p < 0.001), maximum pain scores (p = 0.001), and hospital stay (p < 0.001). Overall postoperative complication rates were similar between both groups (10.8% vs. 12.3%; p = 0.777). The da Vinci SP system continues to offer minimal invasive benefits in rectal cancer surgery. However, the Xi system's instrument diversity provides a certain advantage, particularly in cases involving low-lying rectal tumors. Tailoring robotic approaches based on individual patient characteristics remains pivotal for optimizing outcomes of rectal cancer surgery.

Revisiting Japanese contributions to abdomino-perineal resection for rectal cancer.

Abdominoperineal resection (APR), commonly known as "Miles' operation," is a pivotal technique in rectal cancer surgery. While Miles was credited with formalizing the procedure in 1908, Japanese surgeons Ito and Torikata independently developed a similar approach in 1904, achieving comparable outcomes. Ito and Miles shared several concepts, and each described a critical anatomic challenge during surgery. Ito and Torikata introduced a two-team approach in 1906 that improved surgical safety and efficiency. This article explores Ito and Torikata's contributions and their role in the global development of APR.

Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

Laparoscopic extraperitoneal approach for lateral lymph node dissection for patients with metachronous lateral pelvic lymph node metastases following surgery for rectal cancer: a case series and short-term outcomes.

There have been few reports of a totally extraperitoneal approach for laparoscopic lateral lymph node dissection (LLND) for patients with metachronous lateral pelvic lymph node metastases following surgery for rectal cancer. Therefore, this study reports the short-term outcomes of LLND via an extraperitoneal approach. A total of 10 patients underwent LLND through a laparoscopic extraperitoneal approach in our hospital since October 2018. Patients with suspected resectable lateral lymph node recurrence after surgery for rectal cancer on computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography CT (PET-CT) were selected for this procedure. Nine of the 10 cases were completed using this procedure, but one case was converted to an intraperitoneal approach. The median operative time was 231min, and the median estimated blood loss was 10ml. There was one case of wound infection, but no other postoperative complications were seen. In one patient, no metastases were found in the retrieved lymph nodes. The short-term outcomes of LLND through a laparoscopic extraperitoneal approach were acceptable. Because this procedure can be performed without violating the peritoneum, it is less invasive than the conventional intraperitoneal approach and is useful for metachronous lateral pelvic lymph node metastases.