Robotic-assisted surgery for rectal cancer − results of a non-randomized study

Introduction: The Czech Republic belongs to countries in which colorectal cancer significantly contributes to the overall oncological burden. Radical removal of tumor-affected tissues plays a key role in the multimodal therapy of rectal cancer. In the first decade of the third millennium the mini-invasive approach in rectal cancer surgery gradually expanded to include robotic-assisted surgeries. The aim of this paper is to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. Methods: 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 01 Jan 2016 and 31 Dec 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analyzed − gender, age, body mass index (BMI), ASA (American Society of Anesthesiologist) classification, stage of cancer according to TNM classification (UICC), tumor location, neoadjuvant chemoradiotherapy, operative time, blood loss, anastomotic leaks, surgical complications, 30-day mortality, local and metastatic recurrence and the length of follow-up. The data were analyzed using methods of descriptive statistics. Results: 204 patients with rectal cancer (RC) of whom 138 were men and 66 were women underwent robotic surgery at our department during the five years period. In 97 (47.5%) cases the disease was diagnosed in an advanced stage (stages III and IV of the TNM classification). Eighteen patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the diagnosis. Liver first approach was indicated in 8 (44.4%) patients; two patients underwent radical resection of liver lesions with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease; partial mesorectal excision was performed in 68 cases. Eighteen complications were documented in the entire group. Clinically relevant anastomotic leak with the need of therapy occurred in 5 (3.6%) cases. Surgical therapy was needed in more than half of the cases (61.1%). One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Recurrence of secondary liver disease or metachronous liver lesions occurred in 17 patients, most (76.5%) underwent liver resection with curative intent. The median follow-up period was 20 months. Conclusion: Surgical therapy is the only potentially curative therapy for rectal cancer (RC). Robotic-assisted surgery has become a routine therapeutic modality for RC worldwide during the first two decades of the third millennium. Da Vinci assisted surgeries dominate at the authors’ center in the surgical treatment of RC. Compared to open and laparoscopic resections of RC, robotic-assisted operations achieve the same clinical and oncological results with a lower frequency of complications.