| Background) Neoadjuvant chemoradiotherapy (CRT) for advanced rectal cancer induce edematous change in the surrounding tissues of rectum, which may interfere laparoscopic or robotic procedure. We introduced laparoscopic/robotic surgery for rectal cancer after CRT since 2012. The operative outcomes of these procedures were assessed using propensity score analysis.Patients) A total of 252 cases underwent CRT and surgery. Open surgery was performed in 126 cases, laparoscopic in 88 cases, and robotic in 38 cases.Result) Lateral lymph node metastasis was found in 5.7% of the open, 6.8% of the laparoscopic, and 15.8% of the robotic group. The median operative time was 298 minutes in the open, 348 minutes in the laparoscopic, and 400 minutes in robotic surgery (p<0.01). Conversely, the blood loss was 620ml in the open, 100ml in the laparoscopic, and 50ml in the robotic group (p<0.01). After matching backgrounds using propensity score, the complication rate of laparoscopic surgery was significantly lower than that of open surgery (p=0.026), and that of robotic surgery was also lower than open surgery (p=0.021), but showed no difference from that of laparoscopic surgery (p=0.713). Furthermore, the incidences of postoperative anastomotic leakage in open, laparoscopic, and robotic group were 1.7%, 0% and 0%, respectively.Conclusions) By standardizing the procedures of robot-assisted colorectal surgery, such as patient cart positioning, arm settings, and port-site locations, robotic rectal surgery after CRT was safely introduced and implemented. |
