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Robotic Abdominoperineal Resection

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Surgery for Cancers of the Gastrointestinal Tract

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Abstract

The robotic approach to cancer surgery has grown increasingly popular over the last decade. Colorectal surgery is among the latest disciplines to apply this technology to pelvic surgery as surgeons have recognized the potential technical advantages of the robotic platform particularly for minimally invasive rectal surgery. Robotic technology is particularly applicable to abdominoperineal resection (APR) for distal rectal cancer by facilitating precision, dissection, and wide division of the pelvic floor. In this chapter, the key aspects of robotic APR are highlighted, including patient selection, preoperative preparation, the critical elements of operative technique, and the management of postoperative complications.

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References

  1. Park IJ, You YN, Schlette E, Nguyen S, Skibber JM, Rodriguez-Bigas MA, et al. Reverse-hybrid robotic mesorectal excision for rectal cancer. Dis Colon Rectum. 2012;55(2):228–33. doi:10.1097/DCR.0b013e31823c0bd2.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Lange MM, Rutten HJ, van de Velde CJ. One hundred years of curative surgery for rectal cancer: 1908–2008. Eur J Surg Oncol. 2009;35(5):456–63. doi:10.1016/j.ejso.2008.09.012.

    Article  CAS  PubMed  Google Scholar 

  3. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46. doi:10.1056/NEJMoa010580.

    Article  CAS  PubMed  Google Scholar 

  4. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344(8924):707–11.

    Article  CAS  PubMed  Google Scholar 

  5. Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P, Dutch Colorectal Cancer Group. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23(36):9257–64. doi:10.1200/JCO.2005.02.9231.

    Article  PubMed  Google Scholar 

  6. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8. doi:10.1016/S1470-2045(13)70016-0.

    Article  PubMed  Google Scholar 

  7. Silberfein EJ, Kattepogu KM, Hu CY, Skibber JM, Rodriguez-Bigas MA, Feig B, et al. Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol. 2010;17(11):2863–9. doi:10.1245/s10434-010-1119-8.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Bujko K, Rutkowski A, Chang GJ, Michalski W, Chmielik E, Kusnierz J. Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence? A systematic review. Ann Surg Oncol. 2012;19(3):801–8. doi:10.1245/s10434-011-2035-2.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kim TG, Park W, Choi DH, Kim SH, Kim HC, Lee WY, et al. The adequacy of the distal resection margin after preoperative chemoradiotherapy for rectal cancer. Colorectal Dis. 2014;16(8):O257–63. doi:10.1111/codi.12554.

    Article  CAS  PubMed  Google Scholar 

  10. Rutkowski A, Nowacki MP, Chwalinski M, Oledzki J, Bednarczyk M, Liszka-Dalecki P, et al. Acceptance of a 5-mm distal bowel resection margin for rectal cancer: is it safe? Colorectal Dis. 2012;14(1):71–8. doi:10.1111/j.1463-1318.2010.02542.x.

    Article  CAS  PubMed  Google Scholar 

  11. Eng C, Chang GJ, You YN, Das P, Xing Y, Delclos M, et al. Long-term results of weekly/daily cisplatin-based chemoradiation for locally advanced squamous cell carcinoma of the anal canal. Cancer. 2013;119(21):3769–75. doi:10.1002/cncr.28296.

    Article  CAS  PubMed  Google Scholar 

  12. Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol. 1996;14(9):2527–39.

    CAS  PubMed  Google Scholar 

  13. Mullen JT, Rodriguez-Bigas MA, Chang GJ, Barcenas CH, Crane CH, Skibber JM, et al. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal canal. Ann Surg Oncol. 2007;14(2):478–83. doi:10.1245/s10434-006-9221-7.

    Article  PubMed  Google Scholar 

  14. Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y. T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis. 2011;13(2):138–43. doi:10.1111/j.1463-1318.2010.02380.x.

    Article  CAS  PubMed  Google Scholar 

  15. Marks JH, Kawun UB, Hamdan W, Marks G. Redefining contraindications to laparoscopic colorectal resection for high-risk patients. Surg Endosc. 2008;22(8):1899–904. doi:10.1007/s00464-008-9828-9.

    Article  PubMed  Google Scholar 

  16. Samdani T, Garcia-Aguilar J. Imaging in rectal cancer: magnetic resonance imaging versus endorectal ultrasonography. Surg Oncol Clin N Am. 2014;23(1):59–77. doi:10.1016/j.soc.2013.09.011.

    Article  PubMed  Google Scholar 

  17. Torkzad MR, Kamel I, Halappa VG, Beets-Tan RG. Magnetic resonance imaging of rectal and anal cancer. Magn Reson Imaging Clin N Am. 2014;22(1):85–112. doi:10.1016/j.mric.2013.07.007.

    Article  PubMed  Google Scholar 

  18. van’t Sant HP, Weidema WF, Hop WC, Lange JF, Contant CM. Evaluation of morbidity and mortality after anastomotic leakage following elective colorectal surgery in patients treated with or without mechanical bowel preparation. Am J Surg. 2011;202(3):321–4. doi:10.1016/j.amjsurg.2010.10.018.

    Article  Google Scholar 

  19. Slieker JC, van’t Sant HP, Vlot J, Daams F, Jansen FW, Lange JF. Bowel preparation prior to laparoscopic colorectal resection: what is the current practice? J Laparoendosc Adv Surg Tech A. 2011;21(10):899–903. doi:10.1089/lap.2011.0064.

    Article  PubMed  Google Scholar 

  20. Zmora O, Lebedyev A, Hoffman A, Khaikin M, Munz Y, Shabtai M, et al. Laparoscopic colectomy without mechanical bowel preparation. Int J Colorectal Dis. 2006;21(7):683–7. doi:10.1007/s00384-005-0044-y.

    Article  PubMed  Google Scholar 

  21. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e326S–50. doi:10.1378/chest.11-2298.

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA. 2010;303(24):2479–85. doi:10.1001/jama.2010.841.

    Article  CAS  PubMed  Google Scholar 

  23. Fegiz G, Tonelli F, Rossi P, Di Paola M, De Masi E, Simonetti G. Preservation of the superior hemorrhoidal artery in resection of the colon and rectum. Surg Gynecol Obstet. 1976;143(6):919–25.

    CAS  PubMed  Google Scholar 

  24. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961–9. doi:10.1001/archsurg.2009.170.

    Article  PubMed  Google Scholar 

  25. Hawkins AT, Berger DL, Shellito PC, Sylla P, Bordeianou L. Wound dehiscence after abdominoperineal resection for low rectal cancer is associated with decreased survival. Dis Colon Rectum. 2014;57(2):143–50. doi:10.1097/DCR.0000000000000027.

    Article  PubMed  Google Scholar 

  26. Welsch T, Mategakis V, Contin P, Kulu Y, Buchler MW, Ulrich A. Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications. Int J Colorectal Dis. 2013;28(4):503–10. doi:10.1007/s00384-012-1611-7.

    Article  PubMed  Google Scholar 

  27. West NP, Anderin C, Smith KJ, Holm T, Quirke P, European Extralevator Abdominoperineal Excision Study Group. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010;97(4):588–99. doi:10.1002/bjs.6916.

    Article  CAS  PubMed  Google Scholar 

  28. Butler CE, Gundeslioglu AO, Rodriguez-Bigas MA. Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects. J Am Coll Surg. 2008;206(4):694–703. doi:10.1016/j.jamcollsurg.2007.12.007.

    Article  PubMed  Google Scholar 

  29. Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol. 2011;8(1):51–7. doi:10.1038/nrurol.2010.206.

    Article  PubMed  Google Scholar 

  30. Sartori CA, Sartori A, Vigna S, Occhipinti R, Baiocchi GL. Urinary and sexual disorders after laparoscopic TME for rectal cancer in males. J Gastrointest Surg. 2011;15(4):637–43. doi:10.1007/s11605-011-1459-0.

    Article  PubMed  Google Scholar 

  31. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol. 2012;19(8):2485–93. doi:10.1245/s10434-012-2262-1.

    Article  PubMed  Google Scholar 

  32. Delacroix Jr SE, Winters JC. Voiding dysfunction after pelvic colorectal surgery. Clin Colon Rectal Surg. 2010;23(2):119–27. doi:10.1055/s-0030-1254299.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Warner MA, Warner DO, Harper CM, Schroeder DR, Maxson PM. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology. 2000;93(4):938–42.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA

    Brian K. Bednarski M.D. & George J. Chang M.D., M.S., F.A.C.S., F.A.S.C.R.S.

Authors
  1. Brian K. Bednarski M.D.
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  2. George J. Chang M.D., M.S., F.A.C.S., F.A.S.C.R.S.
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Corresponding author

Correspondence to George J. Chang M.D., M.S., F.A.C.S., F.A.S.C.R.S. .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, City of Hope, Los Angeles, California, USA

    Joseph Kim

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Julio Garcia-Aguilar

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

In this video, the surgeon demonstrates his approach to robotic abdominoperineal resection. (WMV 56771 kb)

Key Operative Steps

  1. 1.

    The patient is placed in low lithotomy position with the robot docked between the legs.

  2. 2.

    Trocars are placed for robotic abdominoperineal resection.

  3. 3.

    Lymphovascular dissection and high vascular ligation of the inferior mesenteric artery is performed.

  4. 4.

    Lateral mobilization of the descending and sigmoid colon joins the medial retromesocolic dissection plane.

  5. 5.

    Total mesorectal excision is performed.

  6. 6.

    Transabdominal incision of the levator ani muscles.

  7. 7.

    Perineal resection and specimen extraction.

  8. 8.

    Maturation of end colostomy.

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Bednarski, B.K., Chang, G.J. (2015). Robotic Abdominoperineal Resection. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_25

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_25

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)

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