Introduction Management of anorectal cancers has evolved with neo-adjuvant chemoradiotherapy and minimal access surgery. Robotic surgery offers benefits of enhanced 3-D vision and articulated instrumentation that facilitate precise dissection, alleviating some of the challenges in the pelvis. The UK adoption of robotic rectal surgery (RRS) has been slow. This study assesses the feasibility and safety of introducing RRS for anorectal cancers. We analysed short-term outcomes with key pathological markers including stage, circumferential resection margin (CRM) and lymph node status.
Method Data collected from a prospective database over a three year period was supplemented by case note review. RRS involves a hybrid approach; the abdominal part performed laparoscopically and the pelvic part robotically.
Results Using the Da Vinci S robot, we performed 38 procedures (23 male: 15 female), median age 64 years (range: 31–82), BMI 26 (17–37) and median ASA 2 (1–4). Indications were 32 rectal cancers (2 recurrent), 2 polyps, 3 anal SCC and 1 peri-anal Pagets’ disease.
Of the rectal cancers 3 (9%) received no radiotherapy; 6 (19%) short course and 23 (72%) long course (CRx). Tumours were sited from anal verge to a height of 17.5 cm (median 5.5 cm).
As a tertiary referral centre with a referral bias towards locally advanced rectal cancers (24 initial staging T3/4) nine tumours required anterior resection (AR), 20 abdominoperineal excision (APR) (1 included resection of seminal vesicles) and 3 posterior clearances. There was one conversion.
Hospital stay ranged 5–25 days (median 8) with no mortality and 4 (13%) complications (National Cancer Institute Common Terminology Criteria for Adverse Events grade 3/4). These include pneumonia, ileus, sepsis with atrial fibrillation (grade 3) and hydronephrosis (grade 4).
Four patients developed recurrent disease (1 local, 1 groin, 2 liver) during median follow up of 8 months (range 0–26). Local recurrence occurred 11 months following APR (prior CRx) for a mucinous carcinoma with a CRM of 1mm. Distant metastases were 5, 18 and 23 months post surgery. One patient died of recurrent disease. There was no 30 day mortality.
Conclusion We performed standard and complex RRS for anorectal cancers, our approach is safe with low morbidity and 0% mortality. Further work is required to assess cost effectiveness, medium and long-term cancer specific and overall outcomes compared to laparoscopic and open techniques.
Disclosure of interest None Declared.