City of Hope surgeons have shown that a robotic-assisted minimally invasive procedure for rectal cancer is just as effective in fighting the disease as ordinary laparoscopic techniques.
Writing in the May issue of Annals of Surgery, City of Hope’s Jeong-Heum Baek, M.D., Ph.D., Alessio Pigazzi, M.D., Ph.D., and colleagues shared their successful experience with robotic total mesorectal excision for the treatment of rectal cancer. It is the first published study documenting long-term data on robotic rectal cancer surgery.
|Robotic surgery offers an effective option for rectal cancer treatment. (Photo by Markie Ramirez)|
In the procedure, surgeons use the da Vinci Surgical System to remove the rectal tumor, a block of rectal and surrounding tissue and numerous nearby lymph nodes. The surgery requires six small punctures in the mid-to-lower abdomen so surgeons may insert instruments and a narrow camera and remove surgical specimens. Pigazzi and colleagues were the first to publish a description of the technique in 2006.
In the latest study, the surgeons followed 72 patients with either stage 0, 1, 2 or 3 disease who received the surgery between late 2004 and mid-2008. The typical patient in the study was monitored for about 20 months.
Cancer recurred locally in about 3 percent of patients, and physicians found distant metastases 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 comparable to those in regular total mesorectal excision procedures, Pigazzi said.
The physicians noted that the robotic surgical technique holds promise because advanced, three-dimensional imaging, flexible instrumentation and increased comfort offer significant improvement over ordinary laparoscopic methods. The surgery also takes about as long as a regular laparoscopic procedure.
Patients quickly regained their bowel function; they were able to start drinking a liquid diet within an average of two days and 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 post-surgery chemotherapy more quickly, the authors wrote.
The surgeons noted that larger, prospective randomized trials are needed to determine the full benefits and limitations of the surgery.