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Minerva Chirurgica 2011 December;66(6):527-35


language: Italian

Robotic rectal resection in rectal cancer: short term results in an monocentric prospective study

Bianchi P. P. 1, Petz W. 1, Spinoglio G. 2, Belotti D. 1, Bertani E. 1, Zampino M. G. 3, Crosta C. 4, Lazzari R. 5, Andreoni B. 1

1 Divisione di Chirurgia Generale e Laparoscopica.Unità di Chirurgia Mini-Invasiva, Istituto Europeo di Oncologia, Università degli Studi di Milano, Milano, Italia; 2 Divisione di Chirurgia Generale ad Indirizzo Oncologico, Ospedale SS Antonio e Biagio, Alessandria, Italia; 3 Divisione di Oncologia Medica, Istituto Europeo di Oncologia, Milano, Italia; 4 Divisione di Endoscopia, Istituto Europeo di Oncologia, Milano, Italia; 5 Divisione di Radioterapia, Istituto Europeo di Oncologia, Milano, Italia


AIM: The aim of this study was to evaluate technical feasibility, oncological safety and short-term clinical results of robotic rectal resection for cancer.
METHODS: From January 2008 to July 2010, 46 patients (27 males and 19 females, median age 69 years, median BMI 24.6 kg/m2) with histologically-proven adenocarcinoma of medium and distal rectum were enrolled in a prospective database. Preoperative assessment was performed with colonoscopy with biopsies, thoraco-abdominal CT scan, pelvic MRI and endorectal-ultrasound (ERUS). In the case of locally advanced non metastatic disease (T3/4 or N1/2), patients received preoperative radiotherapy (45 Grays in 5 weeks) and chemotherapy (oral Capecitabine). The robotic system was a four-arms Da Vinci® (Intuitive Surgical, Sunnyvale, CA, USA); arms position is not modified during the entire surgical procedure.
RESULTS: Twenty-five patients received a preoperative radio-chemotherapy. Surgical procedure was an abdomino-perineal amputation in nine patients and an anterior resection in the remaining 37, with temporary ileostomy in 16 cases and a laparoscopic mobilization of splenic flexure in 25. Median operative time was 251 minutes, median time of first bowel movements 1.7 days and median hospital stay 6.7 days. Major complications requiring reoperation verified in 2 patients, while overall complication rate is 15.2%. Median number of harvested lymph nodes per patient was 18; median distance of the tumour from distal resection margin was 2 cm; distance of the tumour from circumferential margin was superior to 1 mm in all of the patients. At a median follow up of 11 months, all patients are alive and disease-free.
CONCLUSION: Robotic rectal resection is a feasible technique which can provide good oncological and short-term clinical results.

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