Abstract：
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
摘要：
对于T4直肠肿瘤和直肠癌局部复发（LR），TME以外的根治性切除术,有时通过多内脏切除术，对于获得安全利润和提高生存率很重要。对于这些情况，使用腹腔镜方法（LA）仍然存在争议，并且与高转换率相关。然而,机器人手术可能提供一些优势,可以克服LA的一些局限性.因此,我们旨在分析机器人手术治疗局部晚期直肠癌(病理T4)和LR的术后结局和中期肿瘤结果.进行了回顾性分析，包括在11年内在单个机构中接受机器人直肠切除术的患者。病理报告证实为T4肿瘤。主要终点是分析术后并发症（30天）和转换率。次要终点包括标本质量的病理评估，局部复发和生存率[2年无病生存率（DFS）和总生存率（OS）]。共分析了41例患者，包括总共24例（60％）需要多内脏切除术的患者。从肿瘤到肛门直肠连接处的中位距离为7（4-12）cm。2例（5％）需要转换为开放手术。总发病率为78%(n=32)，37%的主要并发症，其中大多数是尿（n=7）。平均住院时间（LOS）为13（7-27）天。30天死亡率为7%(n=3)。由于6例正圆周切缘，在85.4％的病例（n=35）中实现了R0切除。T4肿瘤的2年无病生存率（DFS）和总生存率（OS）分别为72％和85％，分别。局部复发8例(22.2%)；其中6例符合挽救性手术的选择标准。机器人手术治疗局部晚期T4直肠癌和多脏器切除是安全可行的,在本亚组患者中，转换率低，术后发病率可接受。肿瘤学结果已显示与已发表的腹腔镜系列相当，保留切除标本的良好质量。然而,需要进行比较研究和更长的随访期来确认肿瘤学发现,并支持机器人系统在这些复杂的干预措施中的普遍采用.
