Korea University College of Medicine, Korea University Anam Hospital, 126-1 Anam-dong 5-ga, SungBook-gu, Seoul 136-705, Korea.
Surg Endosc. 2011 Sep;25(9):2987-92. doi: 10.1007/s00464-011-1657-6. Epub 2011 Apr 12.
Intersphincteric resection (ISR) for low rectal cancer has been described as the ultimate sphincter-saving procedure. Laparoscopic ISR has been proved safe with early postoperative benefits. Recently, some colorectal surgeons have begun to perform robot-assisted ISR to harness the advantages of the da Vinci robotic system. The authors present their short-term results for a robotic technique of ISR.
Data from 29 consecutive patients at a single institution with very low rectal cancer (<4 cm) from the anal verge who underwent robot-assisted ISR were prospectively collected between December 2007 and March 2010.
The study enrolled 23 men and 6 women with a median age of 61.5 years (range, 36-82 years). Their median body mass index (BMI) was 23.3 kg/m(2) (range, 17.9-32.5 kg/m(2)). The median distance of the tumor from the anal verge was 3 cm (range, 1-4 cm). The median operative time was 325 min (range, 235-435 min), with a console time of 130 min (range, 110-210 min). There were no conversions to open surgery. A protecting ileostomy was performed for all the patients. The median blood loss was less than 50 ml (range, < 50-1,000 ml). The median size of the tumor was 3 cm (range, 0-6.9 cm), and the median number of lymph nodes harvested was 16 (range, 1-44). The median distal margin was 0.8 cm (range, 0-4 cm), and one margin was positive. The circumferential margin was negative (>2 mm) for 27 patients. Therefore, complete resection (R0) was achieved for 26 (90%) of the 29 patients. The median hospital stay was 9 days (range, 5-15 days). Nine patients experienced complications, including three anastomotic leaks (10%). All the leaks were managed conservatively. No surgical mortalities occurred.
Robot-assisted intersphincteric resection for very low rectal cancer is feasible, and its short-term outcome is acceptable.
肛门内括约肌切除术（ISR）被认为是一种终极的保肛手术，用于治疗低位直肠癌。腹腔镜 ISR 已被证明是安全的，具有早期术后获益。最近，一些结直肠外科医生开始使用机器人辅助 ISR 来利用达芬奇机器人系统的优势。作者介绍了他们在机器人 ISR 技术方面的短期结果。
本研究前瞻性地收集了 2007 年 12 月至 2010 年 3 月在一家单中心接受机器人辅助 ISR 治疗的 29 例低位直肠癌（距肛缘＜4cm）患者的资料。
本研究纳入了 23 例男性和 6 例女性患者，中位年龄为 61.5 岁（范围为 36-82 岁）。中位体质指数（BMI）为 23.3kg/m²（范围为 17.9-32.5kg/m²）。肿瘤距肛缘的中位距离为 3cm（范围为 1-4cm）。中位手术时间为 325min（范围为 235-435min），控制台时间为 130min（范围为 110-210min）。无中转开腹手术。所有患者均行保护性回肠造口术。中位出血量＜50ml（范围为＜50-1000ml）。中位肿瘤大小为 3cm（范围为 0-6.9cm），中位淋巴结清扫数目为 16 枚（范围为 1-44 枚）。中位远端切缘为 0.8cm（范围为 0-4cm），1 例切缘阳性。27 例患者的环周切缘阴性（＞2mm）。因此，29 例患者中有 26 例（90%）达到完全切除（R0）。中位住院时间为 9 天（范围为 5-15 天）。9 例患者发生并发症，包括 3 例吻合口漏（10%）。所有漏口均经保守治疗处理。无手术死亡病例。
机器人辅助肛门内括约肌切除术治疗非常低位直肠癌是可行的，其短期结果是可以接受的。
