講演情報
[SY5-4]Expanding the Boundaries of Minimally Invasive Surgery: Robotic Approach for cT4b Colorectal Cancer
*Takahisa Hirokawa1, Naoki Hirano1, Takumi Yamada1, Yuta Shimada1, Tetsuro Miyaike1, Ryutaro Kato1, Yoshiaki Fujii1, Shuhei Ueno1, Yoshinaga Aoyama1, Hiroyuki Imafuji1, Hirotaka Miyai1, Moritsugu Tanaka1, Masahiro Kimura1 (1. Kariya Toyota General Hospital, Japan)
Background: Surgical management of cT4b colorectal cancer remains technically challenging, especially in multivisceral resection. Robotic systems may improve precision and reproducibility of anatomical dissection, although lack of tactile feedback remains a limitation.
Objective: To evaluate surgical outcomes in patients with cT4b colorectal cancer and to clarify the clinical utility and limitations of robotic-assisted surgery.
Methods: We retrospectively reviewed 79 consecutive patients with cT4b colorectal cancer who underwent surgery at our institution between 2017 and 2025. Patients were categorized into open (O, n=24), laparoscopic (L, n=23), and robotic (R, n=29) groups. Operative and short-term outcomes were compared among the three groups.
Results: Median operative time (minutes) was 411, 279, and 461 in the O, L, and R groups, respectively. Median blood loss (mL) was 855, 50, and 210, respectively, indicating reduced intraoperative bleeding in minimally invasive approaches. The incidence of grade ≥3 complications was comparable across groups. R1 resection rates were 16.7%, 8.7%, and 13.8% in the O, L, and R groups, respectively, suggesting acceptable oncological outcomes. Pelvic exenteration, representing highly complex procedures, was performed in 6 patients in the open group and 8 patients in the robotic group, but was not performed in the laparoscopic group.
Conclusions: Although surgery for cT4b colorectal cancer remains highly invasive, minimally invasive approaches contributed to reduced blood loss. Notably, robotic-assisted surgery enabled the management of highly complex cases, including pelvic exenteration, while maintaining oncological feasibility comparable to open surgery. Despite the limitation of lacking tactile feedback, appropriate patient selection based on anatomical landmarks allows safe and effective resection. These findings suggest that robotic surgery may play a key role in expanding the indications of minimally invasive surgery for advanced colorectal cancer.
Objective: To evaluate surgical outcomes in patients with cT4b colorectal cancer and to clarify the clinical utility and limitations of robotic-assisted surgery.
Methods: We retrospectively reviewed 79 consecutive patients with cT4b colorectal cancer who underwent surgery at our institution between 2017 and 2025. Patients were categorized into open (O, n=24), laparoscopic (L, n=23), and robotic (R, n=29) groups. Operative and short-term outcomes were compared among the three groups.
Results: Median operative time (minutes) was 411, 279, and 461 in the O, L, and R groups, respectively. Median blood loss (mL) was 855, 50, and 210, respectively, indicating reduced intraoperative bleeding in minimally invasive approaches. The incidence of grade ≥3 complications was comparable across groups. R1 resection rates were 16.7%, 8.7%, and 13.8% in the O, L, and R groups, respectively, suggesting acceptable oncological outcomes. Pelvic exenteration, representing highly complex procedures, was performed in 6 patients in the open group and 8 patients in the robotic group, but was not performed in the laparoscopic group.
Conclusions: Although surgery for cT4b colorectal cancer remains highly invasive, minimally invasive approaches contributed to reduced blood loss. Notably, robotic-assisted surgery enabled the management of highly complex cases, including pelvic exenteration, while maintaining oncological feasibility comparable to open surgery. Despite the limitation of lacking tactile feedback, appropriate patient selection based on anatomical landmarks allows safe and effective resection. These findings suggest that robotic surgery may play a key role in expanding the indications of minimally invasive surgery for advanced colorectal cancer.