Jin Cheon Kim1,2, Jong Lyul Lee3, Joon Woo Bong3, Ji Hyun Seo3, Chan Wook Kim3, Seong Ho Park4, Jihoon Kim5. 1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea. jckim@amc.seoul.kr. 2. Department of Surgery and Institute of Innovative Cancer Research, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. jckim@amc.seoul.kr. 3. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea. 4. Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea. 5. Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
Abstract
BACKGROUND: Few investigations to date assessing the effectiveness of robot-assisted intersphincteric resection (ISR) have included sufficient patients and follow-up period. This study assessed the utility and safety of robot-assisted ISR by comparing groups of patients who underwent low anterior resection (LAR) with or without ISR and ISR extent. METHODS: This study enrolled 897 patients who underwent curative LAR between 2010 and 2017. Patients were divided into those who did (ISR+) and did not (ISR-) undergo ISR, with the former group subdivided by ISR extent (partial, subtotal, and total). Tumor recurrence and survival were compared in the two groups by one-to-one nearest neighbor matching (218 patients each). RESULTS: Robot-assisted ISR was performed via an entirely transabdominal approach in 93% of patients who underwent LAR. The rate of circumferential margin positivity was ≤ 2% in all patients and did not differ in the ISR- and ISR+ groups or in the three ISR+ subgroups. Mean fecal incontinence score and manometric values deteriorated significantly during postoperative until 12-24 months (p < 0.05 to < 0.001), but recovered subsequently. The 5-year cumulative rates of local recurrence in the ISR+ and ISR- groups were 2.5% and 2.9%, respectively (p = 0.731). The 5-year cumulative rates of overall (86.7% vs. 84.2%, p = 0.899) and disease-free (80.7% vs. 78.5%, p = 0.934) survival did not differ significantly in the ISR+ and ISR- groups. CONCLUSIONS: Because ISR involves resection of low-lying tumors and complex pelvic dissection, robot-assisted ISR via a mostly transabdominal procedure may be technically more efficient, providing lasting anorectal function and good oncologic outcomes.
BACKGROUND: Few investigations to date assessing the effectiveness of robot-assisted intersphincteric resection (ISR) have included sufficient patients and follow-up period. This study assessed the utility and safety of robot-assisted ISR by comparing groups of patients who underwent low anterior resection (LAR) with or without ISR and ISR extent. METHODS: This study enrolled 897 patients who underwent curative LAR between 2010 and 2017. Patients were divided into those who did (ISR+) and did not (ISR-) undergo ISR, with the former group subdivided by ISR extent (partial, subtotal, and total). Tumor recurrence and survival were compared in the two groups by one-to-one nearest neighbor matching (218 patients each). RESULTS: Robot-assisted ISR was performed via an entirely transabdominal approach in 93% of patients who underwent LAR. The rate of circumferential margin positivity was ≤ 2% in all patients and did not differ in the ISR- and ISR+ groups or in the three ISR+ subgroups. Mean fecal incontinence score and manometric values deteriorated significantly during postoperative until 12-24 months (p < 0.05 to < 0.001), but recovered subsequently. The 5-year cumulative rates of local recurrence in the ISR+ and ISR- groups were 2.5% and 2.9%, respectively (p = 0.731). The 5-year cumulative rates of overall (86.7% vs. 84.2%, p = 0.899) and disease-free (80.7% vs. 78.5%, p = 0.934) survival did not differ significantly in the ISR+ and ISR- groups. CONCLUSIONS: Because ISR involves resection of low-lying tumors and complex pelvic dissection, robot-assisted ISR via a mostly transabdominal procedure may be technically more efficient, providing lasting anorectal function and good oncologic outcomes.
Authors: P Ursi; A Santoro; A Gemini; A Arezzo; D Pironi; C Renzi; R Cirocchi; F M Di Matteo; A Maturo; V D'Andrea; J Sagar Journal: G Chir Date: 2018 May-Jun
Authors: Rocco Ricciardi; Patricia L Roberts; Thomas E Read; Nancy N Baxter; Peter W Marcello; David J Schoetz Journal: Dis Colon Rectum Date: 2011-10 Impact factor: 4.585
Authors: R C Dresen; E E M Peters; H J T Rutten; G A P Nieuwenhuijzen; T B J Demeyere; A J C van den Brule; A G H Kessels; R G H Beets-Tan; J H J M van Krieken; I D Nagtegaal Journal: Eur J Surg Oncol Date: 2009-04-11 Impact factor: 4.424
Authors: F Borja de Lacy; Jacqueline J E M van Laarhoven; Romina Pena; María Clara Arroyave; Raquel Bravo; Miriam Cuatrecasas; Antonio M Lacy Journal: Surg Endosc Date: 2017-11-03 Impact factor: 4.584