Short- and long-term outcomes for transvaginal specimen extraction versus minilaparotomy after robotic anterior resection for colorectal cancer: a mono-institution retrospective study

Abstract

Background: Colorectal cancer resection surgery with transvaginal specimen extraction is becoming increasingly accepted and used by surgeons. However, few publications on robotic anterior sigmoid colon and rectal cancer resection with transvaginal specimen extraction (TVSE) have been reported, and a clinical outcome comparison between conventional robotic minilaparotomy (LAP) and transvaginal specimen extraction in anterior sigmoid colon and rectal cancer resection has not been performed. The current study compared the short- and long-term outcomes of TVSE and LAP for sigmoid colon cancer and rectal cancer in a mono-institution.

Methods: From December 2014 to October 2018, 45 patients who underwent TVSE and 45 patients who underwent LAP matched by tumor location, tumor stage, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, gender, and age at the same period were included in the current study. The short- and long-term outcomes of TVSE and LAP were discussed.

Results: No significant differences were found in patient characteristics. For the short-term outcomes, the operative time in the TVSE group was longer than that in the LAP group, and the postoperative pain and additional analgesia were lower in the TVSE group. Patients in the TVSE group required slightly less time to pass first flatus. There were no significant differences in overall complications, time to regular diet, length of hospital stay after surgery, estimated blood loss, or pathological outcomes. For long-term outcomes, the 3-year overall survival (94.9% vs. 91.7%, p = 0.702) and 3-year disease-free survival (88.4% vs. 86.2%, p = 0.758) were comparable between the two groups.

Conclusion: The robotic TVSE is safe and feasible in selected sigmoid/upper rectal cancer patients with tumor diameter < 5 cm. This approach has slightly better short-term outcomes in terms of less postoperative pain and less analgesic requirements without any significant difference in long-term outcomes.

Keywords: Natural orifice specimen extraction; Rectal cancer; Robotic surgery; Sigmoid colon cancer; Transvaginal specimen extraction.

Fig. 1

TVSE surgical procedure. a High tie of the inferior mesenteric artery and inferior mesenteric vein. b A 4­cm posterior colpotomy was performed. c Transvaginal exteriorization of the colon. d Endoluminal, proximal anastomotic site exteriorized. e Plastic bag with the specimen was removed through the vaginal incision. f Endoluminal, through a colpotomy above the diseased segment, proximal anastomotic site not exteriorized. g The posterior incisions were closed using a self­anchoring barbed suture. h Intracorporeal end-to-end colorectal anastomosis. i Postoperative abdominal wall without auxiliary incision

Fig. 2

A 3-year overall survival (OS)

Fig. 3

A 3-year disease-free survival (DFS)