Open Versus Robotic-assisted Techniques for Multivisceral Pelvic Resections of Locally Advanced or Recurrent Colorectal and Anal Cancers: Short-term Outcomes from a Single Centre

Overview

Journal Tech Coloproctol

Date 2024 Nov 19

PMID 39560793

Authors

J Wyatt

E OConnell

M Choi

S G Powell

V Hanchanale

S Ahmed

M A Javed

Affiliations

Soon will be listed here.

Abstract

Background: Pelvic exenterations are now established as a standard of care for locally advanced and recurrent rectal cancer. Traditionally, these radical and complex operations have been performed via an open approach, but with the increasing expertise in robotic-assisted surgery (RAS), there is scope to perform such cases robotically. This study compares outcomes from open and RAS pelvic exenterations.

Methods: This retrospective observational study includes all pelvic exenterations for locally advanced or recurrent colorectal cancers performed in a single centre between September 2018 and September 2023. Cases were grouped into open or RAS surgery and classified in terms of operative extent and complexity. The primary outcome was resection margin status. Secondary outcomes were postoperative morbidity, length of stay and blood loss.

Results: Thirty-three patients were included. Nineteen (57.6%) cases utilised an open technique, and 14 (42.4%) used RAS. Patient characteristics and operative complexity were equivalent between groups. R0 rate (63.1% vs 71.4%, p = 0.719), median haemoglobin drop (19 (11-30) g/L vs 13 (5-26) g/L, p = 0.208) and postoperative morbidity (18/19 (94.7%) vs 9/14 (64.3%), p = 0.062) were equivalent. Length of stay (16.0 days (8-25) vs 9.5 days (6-16), p = 0.047) was shorter in the RAS group.

Conclusions: Short-term surgical and histopathological outcomes are equivalent in this small cohort of patients. This study suggests that RAS may be a safe and effective method for performing pelvic exenterations for colorectal malignancies. Larger-scale and robustly designed prospective studies are required to confirm these preliminary findings and report on long-term oncological outcomes.

References

Heah N, Wong K . Feasibility of robotic assisted bladder sparing pelvic exenteration for locally advanced rectal cancer: A single institution case series. World J Gastrointest Surg. 2020; 12(4):190-196. PMC: 7215973. DOI: 10.4240/wjgs.v12.i4.190. View

Denys A, van Nieuwenhove Y, Van de Putte D, Pape E, Pattyn P, Ceelen W . Patient-reported outcomes after pelvic exenteration for colorectal cancer: A systematic review. Colorectal Dis. 2021; 24(4):353-368. DOI: 10.1111/codi.16028. View

Smith N, Murphy D, Lawrentschuk N, McCormick J, Heriot A, Warrier S . Robotic multivisceral pelvic resection: experience from an exenteration unit. Tech Coloproctol. 2020; 24(11):1145-1153. DOI: 10.1007/s10151-020-02290-x. View

Burns E, Quyn A . The 'Pelvic exenteration lexicon': Creating a common language for complex pelvic cancer surgery. Colorectal Dis. 2023; 25(5):888-896. DOI: 10.1111/codi.16476. View

Weiser M . AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol. 2018; 25(6):1454-1455. DOI: 10.1245/s10434-018-6462-1. View

Simillis C, Baird D, Kontovounisios C, Pawa N, Brown G, Rasheed S . A Systematic Review to Assess Resection Margin Status After Abdominoperineal Excision and Pelvic Exenteration for Rectal Cancer. Ann Surg. 2016; 265(2):291-299. DOI: 10.1097/SLA.0000000000001963. View

Solomon M, Brown K . Extended Radical Resection: The Standard of Care for Patients with Advanced Pelvic Malignancy. Ann Surg Oncol. 2019; 27(2):323-324. DOI: 10.1245/s10434-019-07817-7. View

. Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review. Surg Endosc. 2018; 32(12):4707-4715. DOI: 10.1007/s00464-018-6299-5. View

Fleming C, Harji D, Salut C, Cauvin T, Robert G, Denost Q . Robotic-assisted soft-tissue pelvic exenteration for primary and recurrent pelvic tumours: IDEAL stage 2a evaluation. Br J Surg. 2022; 110(8):923-926. DOI: 10.1093/bjs/znac422. View

10.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

11.

Bonjer H, Deijen C, Abis G, Cuesta M, van der Pas M, de Lange-de Klerk E . A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015; 372(14):1324-32. DOI: 10.1056/NEJMoa1414882. View

12.

Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J . Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA. 2017; 318(16):1569-1580. PMC: 5818805. DOI: 10.1001/jama.2017.7219. View

13.

Muaddi H, Hafid M, Choi W, Lillie E, de Mestral C, Nathens A . Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2020; 273(3):467-473. DOI: 10.1097/SLA.0000000000003915. View

14.

Vigneswaran H, Schwarzman L, Madueke I, MacLaughlan David S, Nordenstam J, Moreira D . Morbidity and Mortality of Total Pelvic Exenteration for Malignancy in the US. Ann Surg Oncol. 2020; 28(5):2790-2800. DOI: 10.1245/s10434-020-09247-2. View

15.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014; 12(12):1495-9. DOI: 10.1016/j.ijsu.2014.07.013. View

16.

Chang T, Chok A, Tan D, Rogers A, Rasheed S, Tekkis P . The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review. J Clin Med. 2021; 10(7). PMC: 8038538. DOI: 10.3390/jcm10071518. View

17.

Harji D, Griffiths B, Velikova G, Sagar P, Brown J . Systematic review of health-related quality of life in patients undergoing pelvic exenteration. Eur J Surg Oncol. 2016; 42(8):1132-45. DOI: 10.1016/j.ejso.2016.01.007. View

18.

. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer. BJS Open. 2019; 3(4):516-520. PMC: 6677093. DOI: 10.1002/bjs5.50153. View

19.

Ng K, Tsia A, Chong V . Robotic Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. World J Surg. 2019; 43(4):1146-1161. DOI: 10.1007/s00268-018-04896-7. View

20.

Larach J, Flynn J, Fernando D, Mohan H, Rajkomar A, Waters P . Robotic beyond total mesorectal excision surgery for primary and recurrent pelvic malignancy: Feasibility and short-term outcomes. Colorectal Dis. 2022; 24(7):821-827. DOI: 10.1111/codi.16136. View