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Robotic-Assisted Surgery for Rectal Adenocarcinoma: Short-term and Midterm Outcomes From 200 Consecutive Cases at a Single Institution

Hara, Masayasu M.D.1,2; Sng, Kevin M.D.1,3; Yoo, Byung Eun M.D.1; Shin, Jae Won M.D.1; Lee, Dong Won M.D.1; Kim, Seon Hahn M.D.1

Diseases of the Colon & Rectum: May 2014 - Volume 57 - Issue 5 - p 570–577
doi: 10.1097/DCR.0000000000000088
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: Although robotic surgery is increasingly used in the management of rectal cancer, its oncologic safety remains uncertain.

OBJECTIVE: We aimed to evaluate the feasibility and safety of robotic-assisted rectal cancer resection in terms of short-term and midterm outcomes.

DESIGN: A prospectively collected set of samples was retrospectively evaluated.

SETTINGS: Data included in this study were collected at a single institution from 2007 to 2011.

PATIENTS: The study included 200 consecutive rectal cancer patients.

INTERVENTION: The patients underwent robotic-assisted resection surgery performed by a single surgeon.

MAIN OUTCOME MEASURES: The short-term (surgical outcome and pathologic data) and midterm outcomes (local pelvic control and overall and disease-free survival) were evaluated and compared with those in the published literature.

RESULTS: The median patient age was 60 years, and the male:female ratio was 2:1. The median distance of rectal tumors from the anal verge was 6 cm. Preoperative radiotherapy was performed in 55 patients. The median operation time was 270 minutes, and the median blood loss was 190 mL. Grade 3 to 5 complications, according to the Clavien-Dindo classification, were observed in 15 patients (7.5%). The circumferential resection margin was positive in 5 patients (2.5%). During the median follow-up period of 29.8 months, recurrence occurred in 27 patients (distant metastasis, 18 patients; local recurrence, 7 patients; and both local recurrence and distant metastases, 2 patients). The local pelvic control and overall and disease-free survival rates of stage III patients at 5 years were 93.0%, 88.6%, and 76.6%.

LIMITATIONS: This was a retrospective, uncontrolled study of selected patients by a single surgeon.

CONCLUSIONS: Our results demonstrated an acceptable morbidity and a low rate of positive circumferential resection margin with effective local control. We also achieved excellent survival data. The midterm oncologic safety justifies the practice of robotic rectal cancer resection to further investigate its role on long-term outcomes.

1Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

2Department of Gastroenterological Surgery, Nagoya City University, Mizuho-cho, Mizuho-ku, Nagoya, Japan

3Department of Surgery, Changi General Hospital, Singapore

Financial Disclosure: None reported.

Correspondence: Seon Hahn Kim, M.D., Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 136–705, Korea. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons