Li-Jen Kuo1,2, James Chi-Yong Ngu3, Yan-Jiun Huang4,5, Yen-Kuang Lin6, Chia-Che Chen7, Yiu-Shun Tong7, Szu-Chia Huang8, Chia-Chen Hu4, Shu-Hwa Tan9. 1. Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan. kuolijen@gmail.com. 2. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. kuolijen@gmail.com. 3. Department of Surgery, Changi General Hospital, Singapore, Singapore. 4. Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan. 5. The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan. 6. Biostatistics and Research Consultation Center, Taipei Medical University, Taipei, Taiwan. 7. Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. 8. Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan. 9. Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR. METHODS: The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed. RESULTS: Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23-89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41-162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007). CONCLUSIONS: This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.
BACKGROUND: Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR. METHODS: The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed. RESULTS: Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23-89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41-162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007). CONCLUSIONS: This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.
Authors: P van Duijvendijk; J F M Slors; C W Taat; W F van Tets; G van Tienhoven; H Obertop; G E E Boeckxstaens Journal: Am J Gastroenterol Date: 2002-09 Impact factor: 10.864
Authors: A Maris; F Penninckx; A M Devreese; F Staes; P Moons; E Van Cutsem; K Haustermans; A D'Hoore Journal: Colorectal Dis Date: 2013-11 Impact factor: 3.788