Complex General Surgical Oncology Fellow The University of Houston MD Anderson Cancer Center Houston, Texas, United States
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Sandra R. DiBrito, MD PhD: Disclosure information not submitted.
Introduction: Surgery for locally advanced colorectal cancer often requires multivisceral or extended pelvic resection to achieve local control and improve survival. The need for extended resection has been considered a contraindication for minimally invasive surgery. This study assessed short-term perioperative and long-term oncologic outcomes of robotic multivisceral and extended pelvic resections.
Methods: Patients who underwent robotic extended or multivisceral resection for colon or rectal cancer at a tertiary cancer center were identified from a prospectively collected database. Patient characteristics, surgical details and short- and long-term outcomes were analyzed. Kaplan-Meier analysis was performed for survival.
Results: Eighty patients were analyzed. Most tumors were in the rectum (81%) and 46% were clinical T4. Twenty-nine patients (36%) had prior abdominal surgery. Most extended resections involved the anterior compartment (73%), including the bladder (n=13), seminal vesicle/vas deferens (n=22), ureter (n=6), prostate (n=15), and uterus, vagina, or adnexa (n=27). Nine cases involved the posterior compartment including coccyx (n=4) and presacral fascia (n=5). Three cases (3.8%) required conversion to open surgery. R0 resections were achieved in 72 (90%) and R1 (CRM ≤1mm) in 8 (10%). Pathological stage was T4 in 15.1%, N+ in 41%, with average nodal yield of 28. Median overall survival was 30.8 months, with 92% alive at 3 years. Median recurrence free survival was 19.4 months, with 3% local recurrence at 1 year, 5% at 2 years. Distant recurrence occurred in 9.8% at 1 year, 26% at 3 years. Median hospital stay was 4 days (IQR 3-7). Major postoperative complications occurred in 8 (10%) patients. Three patients had anastomotic leak, three had deep surgical site infections, and three had wound infections. UTI rate was 4%, urinary retention 7.5%. One patient required reoperation and 9 (11.3%) were readmitted.
Conclusions: Robotic multivisceral and extended resections for locally advanced colorectal cancers can be performed with favorable outcomes allowing more patients to benefit from minimally invasive surgery while preserving oncologic efficacy.
Learning Objectives:
Upon completion, participant will be able to describe the utility of the robotic minimally invasive approach to extended or multivisceral resections for locally advanced colorectal cancers.
Upon completion, participant will be able to conceptualize the risks of a minimally invasive approach to extended or multivisceral resections for locally advanced colorectal cancers.
Upon completion, the participant will be able to describe survival and recurrence of colorectal cancers treated with robotic multivisceral resection.
