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. 2021 Mar 9:11:603073.
doi: 10.3389/fonc.2021.603073. eCollection 2021.

Short-Term and Long-Term Outcomes in Mid and Low Rectal Cancer With Robotic Surgery

Jingwen Chen  1 , Zhiyuan Zhang  1 , Wenju Chang  1 , Tuo Yi  1 , Qingyang Feng  1 , Dexiang Zhu  1 , Guodong He  1 , Ye Wei  1
Affiliations

Short-Term and Long-Term Outcomes in Mid and Low Rectal Cancer With Robotic Surgery

Jingwen Chen et al. Front Oncol. .

Abstract

Objective: To investigate the risk factors for postoperative complications and anastomotic leakage after robotic surgery for mid and low rectal cancer and their influence on long-term outcomes.

Methods: A total of 641 patients who underwent radical mid and low rectal cancer robotic surgery at Zhongshan Hospital Fudan University from January 2014 to December 2018 were enrolled in this study. The clinicopathological factors of the patients were collected. The risk factors for short-term outcomes of complications and anastomotic leakage were analyzed, and their influences on recurrence and overall survival were studied.

Results: Of the 641 patients, 516 (80.5%) underwent AR or LAR procedures, while 125 (19.5%) underwent the NOSES procedure. Only fifteen (2.3%) patients had stoma diversion. One hundred and seventeen patients (17.6%) experienced surgical complications. Anastomotic leakage occurred in 44 patients (6.9%). Eleven patients (1.7%) underwent reoperation within 90 days after surgery. Preoperative radiotherapy did not significantly increase anastomotic leakage in our study (7.4% vs. 6.8%, P = 0.869). The mean postoperative hospital stay was much longer with complication (10.4 vs. 7.1 days, P<0.05) and leakage (12.9 vs. 7.4 days, P < 0.05). Multivariate analysis showed that male sex (OR = 1.855, 95% CI: 1.175-2.923, P < 0.05), tumor distance 5 cm from the anus (OR = 1.563, 95% CI: 1.016-2.404, P < 0.05), and operation time length (OR = 1.563, 95% CI: 1.009-2.421, P < 0.05) were independent risk factors for complications in mid and low rectal cancer patients. The same results for anastomotic leakage: male sex (OR = 2.247, 95% CI: 1.126-4.902, P < 0.05), tumor distance 5 cm from the anus (OR = 2.242, 95% CI: 1.197-4.202, P < 0.05), and operation time length (OR = 2.114, 95% CI: 1.127-3.968, P < 0.05). The 3-year DFS and OS were 82.4% and 92.6% with complication, 88.4% and 94.0% without complication, 88.6% and 93.1% with leakage, and 87.0% and 93.8% without leakage, respectively. The complication and anastomotic leakage showed no significant influences on long-term outcomes.

Conclusion: Being male, having a lower tumor location, and having a prolonged operation time were independent risk factors for complications and anastomotic leakage in mid and low rectal cancer. Complications and anastomotic leakage might have no long-term impact on oncological outcomes for mid and low rectal cancer with robotic surgery.

Keywords: anastomotic leakage; complications; long-term outcomes; rectal cancer; robotic surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow Chart of Enrollment of Mid and Low Robotic Cancer.
Figure 2
Figure 2
Kaplan-Meier curves of disease-free survival and overall survival with or without complication and leakage (survival numbers were added).
See this image and copyright information in PMC

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