title: Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis.
abstract: In recent decades there has been an increasing trend toward sphincter-preserving procedures for the treatment of low rectal cancer. Robotic surgery is considered to be particularly beneficial when operating in the deep pelvis, where laparoscopy presents technical limitations. The aim of this study was to prospectively evaluate the functional outcomes in patients affected by rectal cancer after robotic total intersphincteric resection (ISR) with hand-sewn coloanal anastomosis.
  
  
  
  From March 2008 to October 2012, 23 consecutive patients affected by distal rectal adenocarcinoma underwent robotic ISR. Operative, clinical, pathological and functional data regarding continence or presence of a low anterior resection syndrome (LARS) were prospectively collected in a database.
  
  
  
  Twenty-three consecutive patients were included in the study: 8 men and 15 women. The mean age was 60.2 years (range 28-73). Eighteen (78.3%) had neoadjuvant radiochemotherapy. Conversion rate was nil. The mean operative time was 296.01 min and the mean postoperative hospital stay was 7.43 ± 1.73 days. According to Kirwan's incontinence score, good fecal continence was shown in 85.7% of patients (Grade 1 and 2) and none required a colostomy (Grade 4). Concerning LARS score, the results were as follows: 57.1% patients had no LARS; 19% minor LARS and 23.8% major LARS.
  
  
  
  Robotic total ISR for low rectal cancer is an acceptable alternative to traditional procedures. Extensive discussion with the patient about the risk of poor functional outcomes or LARS syndrome is mandatory when considering an ISR for treatment of low rectal cancer.
authors.affiliation: Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy. Electronic address: fabrizio.luca@ieo.it.
authors.forename: F
authors.initials: F
authors.lastname: Luca
authors.affiliation: Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valvo
authors.affiliation: Department of General Surgery, Centro Médico "Dr. Rafael Guerra Méndez" Valencia, Venezuela.
authors.forename: M
authors.initials: M
authors.lastname: Guerra-Cogorno
authors.affiliation: Unità Operativa di Patologia Chirurgica, Ospedale SS. Annunziata, Chieti, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Simo
authors.affiliation: Servicio de Cirugia General y Aparato Digestivo, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Blesa-Sierra
authors.affiliation: Division of Gastrointestinal Surgery, European Institute of Oncology, Milano, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Biffi
authors.affiliation: Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Garberoglio
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D000714:Anastomosis, Surgical; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012004:Rectal Neoplasms; D012371:Robotics; D016896:Treatment Outcome
keywords: Colorectal surgery; Da Vinci system; Rectal cancer; Robotic surgery