Quality of life after coloanal anastomosis for distal rectal cancer: Long-term functional outcomes

ABSTRACTS in terms of anastomotic leaks. There was no significant difference in the overall survival and local recurrence rate between the two groups. Conclusions: Our results clearly demonstrate that LAR for rectal cancer is not associated with higher morbidity and mortality. On the contrary, according to our data on major complications after OAR, established oncological and surgical principles are respected and long-term outcomes are at least as good as those after open surgery. We believe that more data from randomized studies are needed to confirm our findings. Comunicazione orale: Robot-assisted rectal resection with total mesorectal excision A. Corattia, A. Lombardia,*, G. Caravagliosa, F. Corattia, S. Tumbioloa, P.C. Giulianottia,b a Dpt of Surgery, “Misericordia” Hospital - Grosseto, Italy b Dpt of Surgery, University of Illinois at Chicago, USA * Corresponding author: Antonella Lombardi, “Misericordia Hospital”, Via Senese, 58100 Grosseto, Italy. Tel./fax: +39 0564/485354. E-mail address: [email protected] (A. Lombardi). Background: The role of robotic technology in oncologic colorectal surgery remains to be defined. In this study we evaluated our experience in robotic rectal resection with total mesorectal excision (TME) for cancer. Methods: From November 2000 to March 2012, we performed 52 procedures for oncological rectal disease: 12 abdominoperineal amputations (APR) and 40 rectal anterior resections (RAR). In all, 52 patients (28 males, 24 females; mean age, 66.4 years) underwent robot-assisted rectal resection with TME at the Misericordia Hospital of Grosseto (Tuscany, Italy). A total of 40 rectal anterior restorative resections and 12 abdominoperineal amputations were performed. Of the 40 RAR, 35 were a low anterior resection and 5 an intersphinter resection. Preoperative diagnosis included 45 rectal adenocarcinomas, 2 anal squamous carcinomas, 2 anal melanomas and 3 adenomas. Forty-two (80.7%) patients received neoadjuvant chemoradiation (40 rectal adenocarcinomas with preoperative staging T3N0/+, and 2 anal carcinomas). Recently, we have begun to use a new type of full robotic technique. In the first step, after port placement and patient cart docking, the pelvic steps are performed: inferior mesenteric artery (IMA) resection, sigmoid-colon mobilization and TME. Re-docking of the robotic cart and arms is necessary in the second step (abdominal time): inferior mesenteric vein resection, colon-epiploic medial to lateral dissection, and left colon mobilization. Mechanical or manual anastomosis is then performed (perineal time) under laparoscopic vision. Results: The average operating time was 290.09 min (range, 120-420). No intra- or postoperative blood transfusion was required. No cases required conversion of the procedure. A temporary diverting loop ileostomy was performed in 36 patients. Postoperative mortality and morbidity was 0% and 17.30% (surgical 13.46%), respectively. Five (9.6%) out of the 52 patients were reoperated because of anastomotic leakage in 2 patients, pelvic abscess in 1 patient, postoperative bleeding in 1 patient, and small bowel occlusion. The mean hospital stay was 8.6 days (range, 4-40). TME with negative circumferential and distal margins was successful in all cases (R0 resection); the mean number of lymph nodes harvested was 10.32 (range, 2-30). At a mean follow-up of 43.06 months (range, <1-113), no port site or local recurrence was observed. At long-term follow-up, fecal incontinence, urinary and sexual dysfunction were reported in 6.8% (2/29), 1.9% (1/52), and 8.3% (3/52) of cases, respectively. The 3-year disease-free survival (DFS) was 88.0% and the 3-year overall survival (OS) was 90.0% at long-term follow-up. Conclusions: Early results of robotic rectal surgery seem similar to those of laparoscopic and open techniques. Long-term functional results are excellent and oncological outcomes appear to be very interesting. Quality of life after coloanal anastomosis for distal rectal cancer: Long-term functional outcomes A. Percivale, MD*,*, E. Benatti, MD*, F. Mariani***, G. Saccomani, MD***, R. Pellicci, MD* * Department Department of Surgery e Hepatobiliary Unit e Pietra Ligure, Italy

981 *** Department of Surgery e Colorectal Unit- Pietra Ligure, Italy * Corresponding author: Andrea PERCIVALE MD, Department of Surgery. Santa Corona Hospital e Pietra Ligure e Av. XXV Aprile 38 e 17011, Italy. Tel.: 019.623.2637; Fax: 019.623.5272. E-mail address: [email protected] (A. Percivale). Background: Low anterior resection with coloanal anastomosis after neoadjuvant radiochemotherapy is the standard treatment for distal rectal cancer when a clear distal margin of at least 1 cm is possible. In this retrospective study, the primary end point was to assess long-term quality of life (QOL) and functional results after coloanal anastomosis at a median follow-up of 144 months; the secondary end point was to determine whether preoperative radiotherapy can affect global health and functional results after 10 years of follow-up. Methods: Between 1995 and 2005, 83 patients (80% males; median age, 64 years) underwent low anterior rectal resection and coloanal anastomosis (according to A. Park’s technique) for histologically proven rectal adenocarcinoma (6 to 2 cm from the anal verge). All patients required a temporary fecal diversion (colostomy in 46 patients and ileostomy in 1 patient). The time to diversion closure was 60 to 150 days. Neoadjuvant radiotherapy was delivered in 62% of patients (mean dose, 45 Gy). Seventy-seven patients were alive when the questionnaire survey was administered. Fortyseven patients attended an outpatient clinic. Assessment of QOL and functional results included: 1) physical and rectal examination to evaluate pain, sphincter tone and bleeding; 2) administration of the European Organization for the Research and Treatment of Cancer (EORTC) e QOL questionnaire (a generic core questionnaire for cancer patients [EORTC QLQ-30] and a supplemental disease-specific questionnaire to assess QOL in colorectal cancer patients [EORTC QLQ-CR38]); 3) anal manometry with a Polygraf HR GI Function Testing System (Synectics Medical Carsen Group). Results: No significant differences were seen in operative characteristics, demographics or tumor between the two groups. The mean daily stool frequency was 3.3, with an incidence of overnight soiling of 46%. Anal manometry revealed a mean basal sphincter tone of 45 mm Hg and a maximal tone of 81 mm Hg. The mean volume after rectoanal inhibitory reflex (RAIR) stimulation was 66.25 ml. The QOL-C30 and QOL-CR38 scores for body image ranged between 90% and 95% after restoration of intestinal continuity; the scores for emotional and cognitive functioning were 88% and 96%, respectively. The two groups had similar scores on the general symptoms scale (pain, dyspnea, insomnia) and on the defecation-related symptoms scale (constipation and diarrhea). Low scores for sexual function seemed more related to the advanced age of population when the questionnaires were given than to surgical procedure or preoperative radiotherapy. There were no statistically significant differences between patients who underwent preoperative radiotherapy and those who had not. Conclusions: Coloanal anastomosis after rectal resection for distal rectal cancer has a favorable long-term outcome. It offers the patient good continence with acceptable side effects, which are preferable to a permanent stoma. Neoadjuvant pelvic radiotherapy had no significant adverse effect on bowel function after 10 years follow-up. Robotic versus open rectal resection for cancer: Comparison of clinical and oncological results W. Petz* Unit of Minimally-Invasive Surgery. European Institute of Oncology, Italy Division of General an Laparoscopc Surgery. European Institute of Oncology, Italy Division of Epidemiology and Biostatistics. European Institute of Oncology, Italy * Corresponding author: Wanda Petz. European Institute of Oncology, Via Ripamonti, 435; 20141 Milan. Italy. Tel +39.02.94372053. fax +39.02.94379215. E-mail address: [email protected] (W. Petz). Background: Minimally invasive surgery for rectal cancer has not yet become a standard of care, and few published studies have compared the results of robotic technique with open surgery. We present the clinical