講演情報
[INTS2-1]Advances in Surgical Management of Rectal Cancer: Fascia-Guided Robotic Upfront Mesorectal Excision
*Masakatsu Numata1,2, Keisuke Kazama2, Yosuke Atsumi1,2, Shota Izukawa1,2, Suguru Nukada1,2, Hiroki Ohya2, Kanechika Den2, Emi Ota1,2, Mayumi Ozawa1,2, Tsutomu Sato1,2, Takaki Yoshikawa2 (1. Department of Surgery, Gastroenterological Surgery, Yokohama City University Medical Center, Japan 2. Department of Gastrointestinal Surgery, Yokohama City University, Japan)
Background
Rectal cancer treatment has evolved toward improved local control through two major strategies: surgery and preoperative therapy. Although total TME is the surgical cornerstone, its quality was inadequate in about 40% of cases in the 2000s. Advances in fascial anatomy and robotic technology have enabled precise fascia-based TME even in the deep pelvis. However, most recent evidence is based on preoperative therapy, and outcomes of high-quality TME alone remain unclear. Favorable results of upfront surgery, particularly in Europe, suggest a shift toward risk-adapted treatment strategies.
Objective
To evaluate the oncologic outcomes of fascia-guided ME performed as robotic upfront surgery.
Patients and Methods
We included 125 consecutive patients with pathologically confirmed T3 rectal cancer who underwent robot-assisted surgery at two institutions between June 2017 and August 2023, excluding those with preoperative therapy or stage IV disease. Indications for preoperative therapy were: unresectable cT4b, lateral MRF involvement, anterior T4b requiring downsizing for urinary preservation, lateral lymph node metastasis, and clinical trial enrollment. All procedures involved experienced surgeons. Based on tumor location and T stage, the dissection plane was selected using Denonvilliers’ fascia and pre-hypogastric nerve fascia as landmarks, and fascia-guided ME was performed.
Results
Median age was 70 years, and 68.8% were male; 41.6% had lower rectal tumors. Operative time was 270 minutes and blood loss 5 g. Lateral lymph node dissection was performed in 8.8%, adjacent organ resection in 5.6%, and conversion in 0.8%. Major complications occurred in 5.6%, with anastomotic leakage in 1.6%. R0 resection was achieved in 98.4%. The 3-year local recurrence rate was 2.0% (1.8% in pStage II, 2.4% in pStage III), and overall survival 93.9% with 43 months follow-up period.
Conclusions
Fascia-guided robotic upfront TME provides favorable oncologic outcomes in pT3 rectal cancer. Further evidence, including quality of life may advance rectal cancer management.
Rectal cancer treatment has evolved toward improved local control through two major strategies: surgery and preoperative therapy. Although total TME is the surgical cornerstone, its quality was inadequate in about 40% of cases in the 2000s. Advances in fascial anatomy and robotic technology have enabled precise fascia-based TME even in the deep pelvis. However, most recent evidence is based on preoperative therapy, and outcomes of high-quality TME alone remain unclear. Favorable results of upfront surgery, particularly in Europe, suggest a shift toward risk-adapted treatment strategies.
Objective
To evaluate the oncologic outcomes of fascia-guided ME performed as robotic upfront surgery.
Patients and Methods
We included 125 consecutive patients with pathologically confirmed T3 rectal cancer who underwent robot-assisted surgery at two institutions between June 2017 and August 2023, excluding those with preoperative therapy or stage IV disease. Indications for preoperative therapy were: unresectable cT4b, lateral MRF involvement, anterior T4b requiring downsizing for urinary preservation, lateral lymph node metastasis, and clinical trial enrollment. All procedures involved experienced surgeons. Based on tumor location and T stage, the dissection plane was selected using Denonvilliers’ fascia and pre-hypogastric nerve fascia as landmarks, and fascia-guided ME was performed.
Results
Median age was 70 years, and 68.8% were male; 41.6% had lower rectal tumors. Operative time was 270 minutes and blood loss 5 g. Lateral lymph node dissection was performed in 8.8%, adjacent organ resection in 5.6%, and conversion in 0.8%. Major complications occurred in 5.6%, with anastomotic leakage in 1.6%. R0 resection was achieved in 98.4%. The 3-year local recurrence rate was 2.0% (1.8% in pStage II, 2.4% in pStage III), and overall survival 93.9% with 43 months follow-up period.
Conclusions
Fascia-guided robotic upfront TME provides favorable oncologic outcomes in pT3 rectal cancer. Further evidence, including quality of life may advance rectal cancer management.