title: Anorectal complications after robotic intersphincteric resection for low rectal cancer.
abstract: Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR.
  
  
  
  The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed.
  
  
  
  Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23-89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41-162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007).
  
  
  
  This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan. kuolijen@gmail.com.|Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. kuolijen@gmail.com.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Kuo
authors.affiliation: Department of Surgery, Changi General Hospital, Singapore, Singapore.
authors.forename: James Chi-Yong
authors.initials: JC
authors.lastname: Ngu
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan.|The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan.
authors.forename: Yan-Jiun
authors.initials: YJ
authors.lastname: Huang
authors.affiliation: Biostatistics and Research Consultation Center, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yen-Kuang
authors.initials: YK
authors.lastname: Lin
authors.affiliation: Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Chia-Che
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Yiu-Shun
authors.initials: YS
authors.lastname: Tong
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan.
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Hu
authors.affiliation: Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Shu-Hwa
authors.initials: SH
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012002:Rectal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D013624:Taiwan; D016896:Treatment Outcome
keywords: Anal stenosis; Intersphincteric resection; Mucosal prolapse; Rectal cancer; Robotic surgery