Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain.
Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain.
Updates Surg. 2023 Apr;75(3):589-597. doi: 10.1007/s13304-023-01450-6. Epub 2023 Feb 10.
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
对于 T4 直肠肿瘤和直肠癌局部复发（LR），为获得安全的切缘并提高生存率，需要进行超出 TME 的根治性切除术，有时需要进行多脏器切除术。对于这些病例，腹腔镜（LA）的应用仍然存在争议，并且与高转化率相关。然而，机器人手术可能具有一些优势，可以克服 LA 的一些局限性。因此，我们旨在分析机器人手术治疗局部晚期直肠癌（病理 T4）和 LR 的术后结果和中期肿瘤学结果。对一家机构在 11 年期间进行的机器人直肠切除术的患者进行了回顾性分析，这些患者的病理报告均证实为 T4 肿瘤。主要终点是分析术后并发症（30 天）和转化率。次要终点包括标本质量的病理评估、局部复发和生存[2 年无病生存率（DFS）和总生存率（OS）]。共分析了 41 例患者，其中 24 例（60%）患者需要多脏器切除术。肿瘤距肛门直肠交界处的中位数为 7（4-12）cm。有 2 例（5%）需要转换为开放性手术。总体发病率为 78%（n=32），其中 37%为主要并发症，大多数为尿失禁（n=7）。中位住院时间（LOS）为 13（7-27）天。30 天死亡率为 7%（n=3）。由于 6 例环周切缘阳性，85.4%（n=35）的病例达到了 R0 切除。T4 肿瘤的 2 年无病生存率（DFS）和总生存率（OS）分别为 72%和 85%。有 8 例局部复发（22.2%）；其中 6 例符合挽救性手术的选择标准。对于局部晚期 T4 直肠肿瘤和多脏器切除术，机器人手术是安全可行的，转化率低，该亚组患者的术后发病率可接受。肿瘤学结果表明与已发表的腹腔镜系列结果相当，保留了切除标本的良好质量。然而，需要进行比较研究和更长的随访期，以确认肿瘤学发现并支持机器人系统在这些复杂干预中的广泛应用。
