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COMBINED TATME WITH DA VINCI SP ROBOT FOR LOW ANTERIOR RESECTION IN RECTAL CANCER
Nouran Keshk
*Mayo Clinic, Rochester, MN
Background: Total mesorectal excision (TME) remains the gold standard for resection of rectal cancer regardless of the modality; open, laparoscopic, or robotic. Trans-anal TME (TaTME) approach has been utilized to overcome the difficulties encountered with dissection of tumors in the distal pelvis. Recently, a single-port (SP) robotic Platform was introduced in which 3 arms and a camera emanates from a 2.5 cm diameter port. In this report we present the first experience in the USA combining those 2 approaches in rectal cancer, SPa TaTME, evaluating its safety and oncologic outcomes
Methods: This is a retrospective review of our prospectively maintained rectal cancer database. Pa-tient demographics, tumor characteristics, neoadjuvant treatment, and oncologic and surgical out-comes were recorded.
Results: Between May 2022 and April 2024, a total of 10 patients (6 female, 4 male) with median age at surgery 52.5years (range 37-85 years) and their mean BMI of 26.1 kg/m2 were included. The pre-operative staging was stage III for seven patients and stage II for three patients. Neoadjuvant ther-apy was administered to seven patients, one underwent adjuvant therapy, and another received both neoadjuvant and adjuvant treatments. The final patient declined any medical intervention. The median distance of tumors from the anorectal junction was 3.2 cm (range 1.1-7cm). All patients had negative margins, with eight complete TME specimens, one near complete and only one incomplete. The mean number of lymph nodes harvested was 24.2. Average operative time was 334 minutes. Median follow-up was 15.5 months (range: 4-26 months). The average length of stay was four days. The ileostomy was reversed in eight patients. Five patients had postoperative complications within 60 days (Ileus, Bowel obstruction, Abscess, Anemia requiring transfusion, Urinary tract infection, Deep venous thrombosis). There were no local or distal recurrences.
Conclusions: SPa TaTME is a unique and innovative way of combining two minimally advanced approaches to the resection of distal rectal cancers with safe surgical and oncologic outcomes.
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