Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients

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Abstract
Intersphincteric resection (ISR) for low rectal cancer has been described as the ultimate sphincter-saving procedure. Laparoscopic ISR has been proved safe with early postoperative benefits. Recently, some colorectal surgeons have begun to perform robot-assisted ISR to harness the advantages of the da Vinci robotic system. The authors present their short-term results for a robotic technique of ISR. Data from 29 consecutive patients at a single institution with very low rectal cancer (2 (range, 17.9–32.5 kg/m2). The median distance of the tumor from the anal verge was 3 cm (range, 1–4 cm). The median operative time was 325 min (range, 235–435 min), with a console time of 130 min (range, 110–210 min). There were no conversions to open surgery. A protecting ileostomy was performed for all the patients. The median blood loss was less than 50 ml (range, < 50–1,000 ml). The median size of the tumor was 3 cm (range, 0–6.9 cm), and the median number of lymph nodes harvested was 16 (range, 1–44). The median distal margin was 0.8 cm (range, 0–4 cm), and one margin was positive. The circumferential margin was negative (>2 mm) for 27 patients. Therefore, complete resection (R0) was achieved for 26 (90%) of the 29 patients. The median hospital stay was 9 days (range, 5–15 days). Nine patients experienced complications, including three anastomotic leaks (10%). All the leaks were managed conservatively. No surgical mortalities occurred. Robot-assisted intersphincteric resection for very low rectal cancer is feasible, and its short-term outcome is acceptable.

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