FIRST CLINICAL REPORT OF THE INTERNATIONAL SINGLE PORT ROBOTIC RECTAL CANCER REGISTRY
John H. Marks1, Gyu-Seog Choi2, Taylor Ikner1, Hela Saidi1, Hye Jin Kim2, Deborah S. Keller*1
1Lankenau Institute for Medical Research, Wynnewood, PA; 2Kyungpook National University, Daegu, Korea (the Democratic People's Republic of)
Background: Rectal cancer surgery remains a significant technical challenge. Development and implementation of new technology offers hope for more accurate and precise surgery. To evaluate if single port robotic technology (SPR) helps achieve this goal we established an international SP robotic registry. This study reports short-term clinical and oncological outcomes from an international SPR registry for rectal cancer.
Methods: Review of a prospective international registry of SPR procedures approved for colorectal surgery under an investigational design exemption (IDE) was performed. Patients with rectal adenocarcinoma that had resection for curative intent using the SPR platform through an abdominal approach from 11/2018-9/2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncological and clinical outcome variables. The main outcome measure was the quality of the TME specimen. Secondary outcome measures were intraoperative conversions; R1 resection rate; 30-day postoperative morbidity and mortality.
Results:122 SPR rectal cancer cases were performed at 2 centers by 4 colorectal surgeons. 9 transanal excisions were excluded, leaving 113 cases analyzed. The cohort was 51.32% male, mean age of 59.81years (SD 11.46) and BMI 25.97 kg/m2 (SD 6.13). The most common T-stage was 3 (n=56, 49.56%), followed by 2 (n=24, 21.24%). Three-fourths had preoperative neoadjuvant chemoradiation. The cancers were a mean 2.91cm (SD 2.59) from the anorectal ring and 4.08cm (SD 1.93) in size. The procedures performed were a TATA/TaTME (n=61, 53.98%), low anterior resection (n=49, 43.36%) and abdominoperineal resection (n=3, 2,65%). The mean operating time was 168.71min (SD 56.89). There were no intraoperative complications but 2 (1.77%) conversions to laparoscopy. There was a median of 1 incision, with a mean size of 3.00cm (SD 1.64). The TME specimen was complete in 97.35% (n=110) and near complete in 2.65% (n=3). R1 rate was 3.53% with 3 distal and 1 circumferential positive margin post-operatively, there were 15 total complications, 4 major and 11 minor. There were 2 readmissions (ileus and small bowel obstruction) but no 30-day mortality.
Conclusions: This early international experience with the SPR showed it was a safe and effective technique for distal rectal cancers, with excellent specimen quality. Complications and conversion rates seen with other techniques and platforms used in rectal cancer surgery were not demonstrated. With the use of an international registry, we hope to develop a better understanding of the opportunities and limitations of SPR in rectal cancer surgery as the technology is adopted and applied more widely. While structured training and controlled trials will be required to develop best practices and define the use of the SPR, initial international registry data is encouraging.
Back to 2023 Abstracts