Ann Surg Treat Res.  2018 Jul;95(1):37-44. 10.4174/astr.2018.95.1.37.

Comparative analysis of robot-assisted vs. open abdominoperineal resection in terms of operative and initial oncological outcomes

Affiliations
  • 1Department of Surgery, Asan Medical Center, Institute of Innovative Cancer Research, University of Ulsan College of Medicine, Seoul, Korea. jckim@amc.seoul.kr

Abstract

PURPOSE
The present study aimed to objectively evaluate robot-assisted abdominoperineal resection (APR) in comparison with open APR, in terms of operative elements and initial oncological outcomes.
METHODS
A total of 118 patients with lower rectal adenocarcinoma who had undergone curative APR were consecutively enrolled between June 2010 and June 2016, i.e., robot-assisted group (n = 40) and open group (n = 78).
RESULTS
Transabdominal extralevator muscle excision was more frequently performed in the robot-assisted group than in the open group (68% vs. 42%, P = 0.012). In the robot-assisted group, the pain score at one day after surgery was less than in the open group, and the resumption of bowel function was earlier (P = 0.043 and P = 0.002, respectively). The occurrence of circumferential resection margin involvement (CRM+) was more than 5 times greater in the open group than in the robot-assisted group, presenting a marginal significance (P = 0.057). Although important postoperative morbidity did not generally differ between the 2 groups, voiding difficulty and male sexual dysfunction appeared to be encountered more frequently in the open group than in the robot-assisted group.
CONCLUSION
The robot-assisted APR facilitated transabdominal extralevator excision and bowel recovery and demonstrated a trend towards reduced CRM+.

Keyword

Rectal cancer; Robotics; Abdominoperineal resection

MeSH Terms

Adenocarcinoma
Humans
Male
Rectal Neoplasms
Robotics

Figure

  • Fig. 1 Port positioning and instrument installation for the abdominopelvic phase and pelvic phase using a da Vinci Xi system (Intuitive Surgical Inc., Sunnyvale, CA, USA). All ports are 8 mm, except for the right lateral port used for the Smart stapler and Hemolok (TeleFlex, Westmeath, Ireland). The 8mm endoscope port is placed about 1 cm right and cephalad to the umbilicus. The remaining 3 horizontal ports are then placed on the umbilical line, i.e., 2 lateral ports 2 cm from the midclavicular line, and a left medial port 6–8 cm from the lateral port. Right and left quadrant ports are placed at the McBurney's point and counterMcBurney's point respectively. Instruments used are as follows: tipup fenestrated grasper ①, Maryland bipolar grasper ②, and monopolar curved scissors ④ for the abdominopelvic phase; Maryland bipolar grasper ①, tipup fenestrated grasper ②, monopolar curved scissors ④ for the pelvic phase. E, endoscope port; A, assistant port.

  • Fig. 2 The 2-year postoperative survival outcomes in 113 patients (robot-assisted APR group vs. open APR group, 36 vs. 77 patients) using the KaplanMeier method with the logrank test. Robot-assisted APR group vs. open APR group: 2-year OS, 85.9% vs. 82.9%, P = 0.819; 2-year DFS, 70.7% vs. 67.6%, P = 0.487. APR, abdominoperineal resection; OS, overall survival; DFS, diseasefree survival.


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