Technical, functional, and oncological validity of robot-assisted total-intersphincteric resection (T-ISR) for lower rectal cancer
Few studies fairly compared anorectal function and prognostic outcomes between patients undergoing abdominoperineal resection (APR) and anorectal-function-saving operations (ASO) under the equivalent conditions. By contrast, surgeons used to be somewhat hesitant to conduct total intersphincteric res...
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Veröffentlicht in: | European journal of surgical oncology 2023-01, Vol.49 (1), p.188-195 |
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description | Few studies fairly compared anorectal function and prognostic outcomes between patients undergoing abdominoperineal resection (APR) and anorectal-function-saving operations (ASO) under the equivalent conditions. By contrast, surgeons used to be somewhat hesitant to conduct total intersphincteric resection (T-ISR) as maximal ASO, due to its technical complexity and potential anorectal dysfunction.
Propensity-score matched cohorts undergoing robot-assisted R0 surgery [T-ISR vs APR vs partial-subtotal ISR (PS-ISR)/lower anterior resection (LAR)] for rectal cancer (n = 1361) were included. Operative outcomes, recurrence, and disease-free/overall survival (DFS/OS) were analyzed. Anorectal function was evaluated based on fecal incontinence score and high-resolution manometry between the T-ISR and other ASO groups.
Few differences were detected between the T-ISR and APR groups. More patients undergoing APR had T4 stage disease, while the lowest tumor margin was the same in both groups (mean, 1.5 cm from anal verge). Prognostic outcomes did not differ between the T-ISR and APR groups, including local (5.1% vs 7.7%, p = 1) or systemic (15.4% vs 25.6%, p = 0.401) recurrence, and 5-year DFS (78.7% vs 61.5%, p = 0.1) and OS (89% vs 82.1%, p = 0.434) rates, nor were there differences between the T-ISR and PS-ISR/LAR groups. The PS-ISR group generally showed less anorectal dysfunction than the T-ISR group, but maximal tolerance volume did not differ between these two groups and was within the range for the healthy population.
T-ISR can replace most traditional APR, except for advanced T4 disease with aggressive infiltration into the levator-sphincters, and can provide tolerable anorectal dysfunction. |
doi_str_mv | 10.1016/j.ejso.2022.07.010 |
format | Article |
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Propensity-score matched cohorts undergoing robot-assisted R0 surgery [T-ISR vs APR vs partial-subtotal ISR (PS-ISR)/lower anterior resection (LAR)] for rectal cancer (n = 1361) were included. Operative outcomes, recurrence, and disease-free/overall survival (DFS/OS) were analyzed. Anorectal function was evaluated based on fecal incontinence score and high-resolution manometry between the T-ISR and other ASO groups.
Few differences were detected between the T-ISR and APR groups. More patients undergoing APR had T4 stage disease, while the lowest tumor margin was the same in both groups (mean, 1.5 cm from anal verge). Prognostic outcomes did not differ between the T-ISR and APR groups, including local (5.1% vs 7.7%, p = 1) or systemic (15.4% vs 25.6%, p = 0.401) recurrence, and 5-year DFS (78.7% vs 61.5%, p = 0.1) and OS (89% vs 82.1%, p = 0.434) rates, nor were there differences between the T-ISR and PS-ISR/LAR groups. The PS-ISR group generally showed less anorectal dysfunction than the T-ISR group, but maximal tolerance volume did not differ between these two groups and was within the range for the healthy population.
T-ISR can replace most traditional APR, except for advanced T4 disease with aggressive infiltration into the levator-sphincters, and can provide tolerable anorectal dysfunction.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2022.07.010</identifier><identifier>PMID: 35864011</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Abdominoperineal resection (APR) ; Anal Canal - pathology ; Anal Canal - surgery ; Disease-Free Survival ; Functional anatomy ; Humans ; Oncological validity ; Prognosis ; Rectal cancer ; Rectal Neoplasms - pathology ; Robot-assisted ; Robotics ; Total intersphincteric resection (T-ISR) ; Treatment Outcome</subject><ispartof>European journal of surgical oncology, 2023-01, Vol.49 (1), p.188-195</ispartof><rights>2022</rights><rights>Copyright © 2022. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-ef4433b246df930bfb8ed2fcfa6f17ffdb5842798b47f290cc2183aeaedd47063</citedby><cites>FETCH-LOGICAL-c356t-ef4433b246df930bfb8ed2fcfa6f17ffdb5842798b47f290cc2183aeaedd47063</cites><orcidid>0000-0002-8694-4365</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejso.2022.07.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35864011$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Jin Cheon</creatorcontrib><creatorcontrib>Lee, Jong Lyul</creatorcontrib><creatorcontrib>Kim, Chan Wook</creatorcontrib><creatorcontrib>Kim, Jung Rang</creatorcontrib><creatorcontrib>Kim, Jihun</creatorcontrib><creatorcontrib>Park, Seong Ho</creatorcontrib><title>Technical, functional, and oncological validity of robot-assisted total-intersphincteric resection (T-ISR) for lower rectal cancer</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Few studies fairly compared anorectal function and prognostic outcomes between patients undergoing abdominoperineal resection (APR) and anorectal-function-saving operations (ASO) under the equivalent conditions. By contrast, surgeons used to be somewhat hesitant to conduct total intersphincteric resection (T-ISR) as maximal ASO, due to its technical complexity and potential anorectal dysfunction.
Propensity-score matched cohorts undergoing robot-assisted R0 surgery [T-ISR vs APR vs partial-subtotal ISR (PS-ISR)/lower anterior resection (LAR)] for rectal cancer (n = 1361) were included. Operative outcomes, recurrence, and disease-free/overall survival (DFS/OS) were analyzed. Anorectal function was evaluated based on fecal incontinence score and high-resolution manometry between the T-ISR and other ASO groups.
Few differences were detected between the T-ISR and APR groups. More patients undergoing APR had T4 stage disease, while the lowest tumor margin was the same in both groups (mean, 1.5 cm from anal verge). Prognostic outcomes did not differ between the T-ISR and APR groups, including local (5.1% vs 7.7%, p = 1) or systemic (15.4% vs 25.6%, p = 0.401) recurrence, and 5-year DFS (78.7% vs 61.5%, p = 0.1) and OS (89% vs 82.1%, p = 0.434) rates, nor were there differences between the T-ISR and PS-ISR/LAR groups. The PS-ISR group generally showed less anorectal dysfunction than the T-ISR group, but maximal tolerance volume did not differ between these two groups and was within the range for the healthy population.
T-ISR can replace most traditional APR, except for advanced T4 disease with aggressive infiltration into the levator-sphincters, and can provide tolerable anorectal dysfunction.</description><subject>Abdominoperineal resection (APR)</subject><subject>Anal Canal - pathology</subject><subject>Anal Canal - surgery</subject><subject>Disease-Free Survival</subject><subject>Functional anatomy</subject><subject>Humans</subject><subject>Oncological validity</subject><subject>Prognosis</subject><subject>Rectal cancer</subject><subject>Rectal Neoplasms - pathology</subject><subject>Robot-assisted</subject><subject>Robotics</subject><subject>Total intersphincteric resection (T-ISR)</subject><subject>Treatment Outcome</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1r3DAQhkVISbZp_0AORccUamck2ZYNuYTQj0Cg0GzPQpZGiRavtZW0Kbn2l1fupj1WlxHM-z4wDyHnDGoGrLvc1LhJoebAeQ2yBgZHZMVawSvOWnlMViCbvpJDL07J65Q2ADAIOZyQU9H2XQOMrcivNZrH2Rs9faBuP5vsw7z89WxpmE2YwsOypE968tbnZxocjWEMudIp-ZTR0hyynio_Z4xp9-gLA6M3NGLCPzh6sa5u77-9py5EOoWfGMvOlA41ejYY35BXTk8J377MM_L908f1zZfq7uvn25vru8qItssVuqYRYuRNZ90gYHRjj5Y743TnmHTOjm3f8HLt2EjHBzCGs15o1GhtI6ETZ-TiwN3F8GOPKautTwanSc8Y9knxrtgpT0CJ8kPUxJBSRKd20W91fFYM1OJebdTiXi3uFUhV3JfSuxf-ftyi_Vf5K7sErg4BLFc-eYwqGY9FgfWLEGWD_x__N63mmEs</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Kim, Jin Cheon</creator><creator>Lee, Jong Lyul</creator><creator>Kim, Chan Wook</creator><creator>Kim, Jung Rang</creator><creator>Kim, Jihun</creator><creator>Park, Seong Ho</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8694-4365</orcidid></search><sort><creationdate>202301</creationdate><title>Technical, functional, and oncological validity of robot-assisted total-intersphincteric resection (T-ISR) for lower rectal cancer</title><author>Kim, Jin Cheon ; Lee, Jong Lyul ; Kim, Chan Wook ; Kim, Jung Rang ; Kim, Jihun ; Park, Seong Ho</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-ef4433b246df930bfb8ed2fcfa6f17ffdb5842798b47f290cc2183aeaedd47063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominoperineal resection (APR)</topic><topic>Anal Canal - pathology</topic><topic>Anal Canal - surgery</topic><topic>Disease-Free Survival</topic><topic>Functional anatomy</topic><topic>Humans</topic><topic>Oncological validity</topic><topic>Prognosis</topic><topic>Rectal cancer</topic><topic>Rectal Neoplasms - pathology</topic><topic>Robot-assisted</topic><topic>Robotics</topic><topic>Total intersphincteric resection (T-ISR)</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Jin Cheon</creatorcontrib><creatorcontrib>Lee, Jong Lyul</creatorcontrib><creatorcontrib>Kim, Chan Wook</creatorcontrib><creatorcontrib>Kim, Jung Rang</creatorcontrib><creatorcontrib>Kim, Jihun</creatorcontrib><creatorcontrib>Park, Seong Ho</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Jin Cheon</au><au>Lee, Jong Lyul</au><au>Kim, Chan Wook</au><au>Kim, Jung Rang</au><au>Kim, Jihun</au><au>Park, Seong Ho</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Technical, functional, and oncological validity of robot-assisted total-intersphincteric resection (T-ISR) for lower rectal cancer</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2023-01</date><risdate>2023</risdate><volume>49</volume><issue>1</issue><spage>188</spage><epage>195</epage><pages>188-195</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Few studies fairly compared anorectal function and prognostic outcomes between patients undergoing abdominoperineal resection (APR) and anorectal-function-saving operations (ASO) under the equivalent conditions. By contrast, surgeons used to be somewhat hesitant to conduct total intersphincteric resection (T-ISR) as maximal ASO, due to its technical complexity and potential anorectal dysfunction.
Propensity-score matched cohorts undergoing robot-assisted R0 surgery [T-ISR vs APR vs partial-subtotal ISR (PS-ISR)/lower anterior resection (LAR)] for rectal cancer (n = 1361) were included. Operative outcomes, recurrence, and disease-free/overall survival (DFS/OS) were analyzed. Anorectal function was evaluated based on fecal incontinence score and high-resolution manometry between the T-ISR and other ASO groups.
Few differences were detected between the T-ISR and APR groups. More patients undergoing APR had T4 stage disease, while the lowest tumor margin was the same in both groups (mean, 1.5 cm from anal verge). Prognostic outcomes did not differ between the T-ISR and APR groups, including local (5.1% vs 7.7%, p = 1) or systemic (15.4% vs 25.6%, p = 0.401) recurrence, and 5-year DFS (78.7% vs 61.5%, p = 0.1) and OS (89% vs 82.1%, p = 0.434) rates, nor were there differences between the T-ISR and PS-ISR/LAR groups. The PS-ISR group generally showed less anorectal dysfunction than the T-ISR group, but maximal tolerance volume did not differ between these two groups and was within the range for the healthy population.
T-ISR can replace most traditional APR, except for advanced T4 disease with aggressive infiltration into the levator-sphincters, and can provide tolerable anorectal dysfunction.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35864011</pmid><doi>10.1016/j.ejso.2022.07.010</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8694-4365</orcidid></addata></record> |
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source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
subjects | Abdominoperineal resection (APR) Anal Canal - pathology Anal Canal - surgery Disease-Free Survival Functional anatomy Humans Oncological validity Prognosis Rectal cancer Rectal Neoplasms - pathology Robot-assisted Robotics Total intersphincteric resection (T-ISR) Treatment Outcome |
title | Technical, functional, and oncological validity of robot-assisted total-intersphincteric resection (T-ISR) for lower rectal cancer |
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