Imagine removing cancer from sensitive areas of the body using only the smallest incisions — surgery so delicate and precise that a patient can bounce back and return home faster than ever before. Called minimally invasive or laparoscopic surgery, these techniques have revolutionized operations on the heart, prostate, gall bladder and many other organs.
In minimally invasive procedures, surgeons use a camera and narrow instruments inserted through small openings in the skin to remove and repair tissue.
 Surgeons use robotic-assisted surgery to remove rectal tumors and nearby tissue and lymph nodes. (Image by Alan Hoofring/Courtesy of the National Cancer Institute) |
But the benefits haven't reached many patients with rectal cancer, possibly because of the confined space and difficulty of the procedures. Now City of Hope surgeons have found that adding a surgical robot to the mix can help. The surgeons showed that minimally invasive surgery using a robot is just as effective in fighting rectal cancer as regular laparoscopic surgery — but it may be more convenient.
In the first published study showing a long-term look at robotic rectal cancer surgery, City of Hope surgeons Jeong-Heum Baek, M.D., Ph.D., Alessio Pigazzi, M.D., Ph.D., and colleagues shared their successful experience with a procedure called total mesorectal excision.
In the procedure, surgeons use robotic-assisted surgery to remove a rectal tumor, a block of surrounding tissue and several nearby lymph nodes. Lymph nodes are small organs in the immune system that trap foreign and diseased cells.
In the study, the surgeons watched over 72 patients with either stage 0, 1, 2 or 3 disease for about 20 months.
Cancer came back close to the original location in about 3 percent of patients. It spread to other places in the body in more than 6 percent of patients. More than 96 percent of patients were still alive three years after surgery, and nearly 74 percent of them had no cancer after that time. Patients experienced few complications.
These results are similar to those in regular total mesorectal excision procedures, Pigazzi said.
The physicians noted that the robotic surgical technique is promising because advanced 3-D imaging, flexible instruments and increased comfort offer significant improvement over ordinary laparoscopic methods. The surgery also takes about the same time as a regular laparoscopic procedure.
Patients quickly regained their bowel function and could start drinking a liquid diet within an average of two days. They left the hospital after about five days, significantly faster than in open procedures. Such rapid recovery times may be important to helping patients start their postsurgery chemotherapy more quickly, according to the researchers.
The surgeons noted that further studies are needed to determine the full benefits and limitations of the surgery.
