Robot-Assisted Abdominoperineal Resection: Clinical, Pathologic, and Oncologic Outcomes.
BACKGROUND
The extralevator approach to abdominoperineal resection is associated with a decreased incidence of rectal perforation and circumferential resection margin positivity translating to lower recurrence rates. The abdominoperineal resection, as such, is an operation associated with poorer outcomes in comparison with low anterior resections, and any improvements in short-term outcomes are likely to be related to surgical technique. Robot assistance in extralevator abdominoperineal resection has shown improvement in these pathologic outcomes. Because these are surrogate markers for local recurrence and disease-free survival, long-term survival data are needed to assess the efficacy of this robot-assisted technique, exclusively in a dedicated abdominoperineal resection cohort.


OBJECTIVE
We assessed the perioperative, pathologic, and oncologic outcomes of the robot-assisted extralevator abdominoperineal resection for rectal cancer.


METHODS
This study was a review of a prospective database of patients over a 5-year period.


METHODS
Procedures were performed in the colorectal division of a tertiary hospital from April 2007 to July 2012.


METHODS
Patients with rectal cancer were operated on robotically. Indications for abdominoperineal resection were low rectal cancers invading the sphincter complex or location in the anal canal precluding anastomosis.


METHODS
All patients received a robot-assisted extralevator abdominoperineal resection.


METHODS
Operative and perioperative measures, pathologic outcomes, and disease-free survival and overall survival were documented and assessed.


RESULTS
Twenty-two patients (15 men) with a mean age of 65.5 years and mean BMI of 28.6 kg/m underwent robotic abdominoperineal resection. Circumferential resection margin was positive in 13.6%. There was 1 tumor/rectal perforation. At a mean follow-up of 33.9 months, overall survival was 81.8% with a disease-free survival of 72.7%. Local recurrence was 4.5%.


CONCLUSIONS
This was a single-institution study with no comparative open or laparoscopic group.


CONCLUSIONS
Robot-assisted abdominoperineal resection is safe, feasible, and oncologically sound with short-term and long-term outcomes comparable to open and laparoscopic surgery.
1 Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois 2 Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois 3 James R. and Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Saleh M
SM
Eftaiha
Ajit
A
Pai
Suela
S
Sulo
John J
JJ
Park
Leela M
LM
Prasad
Slawomir J
SJ
Marecik
D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome