title: Robotic Site Adjusted Levator Transection for Carcinoma of the Rectum: A Modification of the Existing Cylindrical Abdominoperineal Resection for Eccentrically Located Tumors.
abstract: Today, extralevator abdominoperineal resection is the standard of care for low rectal cancers with sphincter involvement or location precluding anastomosis. This procedure, while effective from an oncologic point of view, is morbid, with a high incidence of wound complications and genitourinary, and sexual dysfunction. We present a modification of this procedure via a robotic approach, which maintains the radicality while reducing the soft tissue loss and potentially the morbidity.
  
  
  
  Over a 2-year period, five patients (four men and one woman) with eccentric low rectal cancers following neoadjuvant chemoradiation underwent a robot-assisted modified abdominoperineal resection with wide levator transection on the tumor side and conservative levator division on the opposite side. These patients were prospectively followed. Perioperative outcomes, pathologic specimen measures, wound-related problems, and local and systemic recurrences were documented and analyzed.
  
  
  
  All procedures were successfully completed without conversion. Average body mass index was 32 kg/m2. The mean operative time and blood loss were 370 min and 130 ml, respectively. All specimens had an intact mesorectal envelope with no tumor perforations, and the mean lymph node yield was 16. There were no urinary complications or perineal wound infections. At a median follow-up of 14 months, all patients remain disease-free.
  
  
  
  Modified robotic cylindrical abdominoperineal resection with site adjusted levator transection for rectal cancer is an oncologically sound operation in eccentrically located tumors. It maintains the radicality of conventional extralevator abdominoperineal resection, while also reducing the soft tissue loss and thereby potentially the morbidity.
authors: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL, 60068, USA.|Department of Surgical Oncology, Apollo Hospitals, Chennai, India.
authors: Ajit
authors: A
authors: Pai
authors: Department of Surgical Oncology, Apollo Hospitals, Chennai, India. seftaiha@gmail.com.
authors: Saleh Mohamed
authors: SM
authors: Eftaiha
authors: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL, 60068, USA.|Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminister, BC, Canada.
authors: George
authors: G
authors: Melich
authors: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL, 60068, USA.
authors: John J
authors: JJ
authors: Park
authors: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL, 60068, USA.
authors: Pey-Yi Kevin
authors: PK
authors: Lin
authors: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL, 60068, USA.|Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors: Leela M
authors: LM
authors: Prasad
authors: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, IL, 60068, USA.|Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors: Slawomir J
authors: SJ
authors: Marecik
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000628:therapy*; D016063:Blood Loss, Surgical; D059186:Chemoradiotherapy, Adjuvant; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D010502:Perineum / Q000601:surgery; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000628:therapy*; D065287:Robotic Surgical Procedures / Q000379:methods*