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Rectal Diseases

Patients undergoing robotic Transabdominal Top-down Intersphincteric Resection with Double-stapling Coloanal Anastomosis

1. Patients with rectal cancer.
2. Patients will undergo robotic Transabdominal Top-down Intersphincteric Resection with Double-stapling Coloanal Anastomosis

Robotic surgery

Jin-Tung LIANG, PhD

The present study is to develop the novel robotic surgical technique and enhance the surgery quality for the treatment of distal rectal cancer.

The intersphincteric resection (ISR) for the treatment of distal rectal cancer has been a complex two-step surgical procedure consisting of transabdominal mobilization of the anorectum and transanal bowel resection with handsewn coloanal anastomosis. The availability of robotic systems may facilitate the transabdominal approach, simplify the surgical procedures, and achieve better anorectal function for patients with distal rectal cancer requiring an ISR. Consecutive 40 patients with distal rectal cancer undergoing the single-step robotic transabdominal ISR with the intent-to-treat principle will be recruited. The risk factors for a failed transabdominal ISR were identified from the prospectively maintained clinicopathologic data using univariate and multivariate analysis. The surgical outcomes, the anorectal function, and the tumor recurrence were compared between patients with a successful or failed robotic transabdominal ISR. The investigators believe that the present project can facilitate the development of the novel robotic surgical technique and enhance the surgery quality for the treatment of distal rectal cancer in our hospital and even in Taiwan.

Robotic Top-down Intersphincteric Resection

A Feasibility Study of Robotic Transabdominal Top-down Intersphincteric Resection With Double-stapling Coloanal Anastomosis for Distal Rectal Cancer

1. The total mobilization and transection of anorectum was performed in the transabdominal down sequence, followed by the double-stapling technique for the coloanal anastomosis;
2. the proximal and distal stapled tissue doughnuts recovered from EEA device were intact;
3. A variable length of muscular cuff of proximal internal anal sphincter was removed with a TME specimen;
4. To define a successful transabdominal total ISR, besides the above-mentioned three criteria, the anastomotic site should be checked by immediate anoscopy to confirm the stapling line is approximately at the level of anal intersphincteric groove.

The radicality of CRM will be evaluated by a pathologist for any tumor invasion

The radicality of distal and proximal margin

The duration between skin incision and wound dressing

One of the most common postoperative complication

The total days of stay in hospital during postoperative period

the presence of thin discharge or local abscess in the operative wound, followed by the confirmation with Gram stains or bacterial cultures.

The presence of clinical features of peritonitis and bowel contents in the drainage during hospitalization.

a defect at the anastomotic site that results in a communication with the bowel lumen.

Standardized questionnaire was given to patients to assess disability that included the number of days until return to partial activity, full activity, and work on the basis of their subjective responses.

Wexner score, also known as Cleveland Clinic Fecal Incontinence Severity Scoring System (CCIS) is a fecal incontinence score from 0-20; where 0 is perfect continence and 20 is complete incontinence.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Robotic Top-down Intersphincteric Resection	NCT05961969	Colorectal Canc...	Robotic surgery	20 Years - 75 Years	National Taiwan University Hospital
Robotic Top-down Intersphincteric Resection	NCT05961969	Colorectal Canc...	Robotic surgery	20 Years - 75 Years	National Taiwan University Hospital
Robotic Top-down Intersphincteric Resection	NCT05961969	Colorectal Canc...	Robotic surgery	20 Years - 75 Years	National Taiwan University Hospital

Spots Global Cancer Trial Database for intersphincteric resection (isr)