Annals of Coloproctology

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Minimally invasive surgery

A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer: René Reyes, Csaba Kindler, Kenneth Smedh, Catarina Tiselius; Ann Coloproctol. 2024;40(2):154-160. Published online December 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00332.0047

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Purpose
The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer.
Methods
All patients who underwent resection for rectal cancer from 2016 to 2018 were included (n=137). Specimens were divided into 3 sections to analyze the pathology of the lymph nodes.
Results
The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean±standard deviation: 29.1±8.6 cm vs. 33.8±9.9 cm, P=0.004) because of a shorter proximal resection margin (21.7±8.7 cm vs. 26.4±10.6 cm, P=0.006). The number of recruited lymph nodes (35.8±21.8 vs. 39.6±16.5, P=0.604) and arterial vessel length (8.84±2.6 cm vs. 8.78±2.4 cm, P=0.891) did not differ significantly between the 2 surgical approaches. Lymph node metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic lymph nodes were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups.
Conclusion
There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of lymph node metastases, and resection margins.

Citations

Citations to this article as recorded by

Robotic Surgery for Rectal Cancer Treatment: Clinical Outcomes and Quality of Life. Comparison of Surgical Methods
Raminta Akelaitytė, Justas Žilinskas
Lietuvos chirurgija.2025; 24(3): 184. CrossRef
Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Han
Annals of Coloproctology.2024; 40(2): 87. CrossRef
Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis
E. Barzola, L. Cornejo, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, K. A. Bobb, R. Farrés, P. Planellas
Journal of Robotic Surgery.2023; 17(6): 3013. CrossRef

Clinical Significance of Occult Micrometastases in Colorectal Cancer.: Lee, Suk Hwan , Kim, Tae Young , Kim, Yoon Wha , Koh, Suck Hwan , Yoon, Choong , Oh, Soo Myung , Lee, Kee Hyung; J Korean Soc Coloproctol. 2000;16(2):78-86.

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Abstract PDF: BACKGROUND
One of the most important prognostic factors in colorectal cancer is lymph node metastasis, which predicts a reduced survival time. Although lymph node metastases were not detected by a conventional hematoxylin-eosin stain technique, 20 to 30 percent of patients fail long-term survival on account of a local or systemic recurrence. Recurrent disease in these patients is believed to develop from occult tumor in lymph nodes. PURPOSE: The authors have conducted an immunohistochemical study with two different antibodies against cytokeratin to identify occult micrometastases in lymph nodes which were diagnosed as tumor negative by conventional histopathology.
METHODS
Paraffin blocks of sixty-five patients with colorectal cancer (T2/3, N0, M0) after a curative resection between January 1991 and December 1993 at Kyung-Hee University Hospital were stained with avidin-biotin-peroxidase complex technique using two monoclonal antibodies (anti-cytokeratin AE1/AE3 and anti-cytokeratin No. 20, DAKO, Hamburg, Germany). To assess the clinical correlation between micrometastasis in lymph node and patients survial, 5-year disease-free survival rates were calculated by Kaplan-Meier method and the significance of the differences was estimated by the log-rank test. P values <0.05 were taken to be significant.
RESULTS
Of the sixty-five patients with 1133 lymph nodes, tumor cells detected by anti-cytokeratin AE1/AE3 and anti-cytokeratin No. 20, were 2.4 percent (27/1133) and 3.4 percent (38/1133), respectively. Micrometastases were detected in twenty-six patients (40.0 percent). The histologic stage of four cytokeratin positive cases was upstaged from T2, N0, M0 to T2, N1/2, M0, and twenty-two of T3, N0, M0 to T3, N1/2, M0. Cytokeratin-positive cases showed statistically significant recurrence rate (42.3 percent) compared to that of cytokeratin -negative cases (17.9 percent)(x2 test, p=0.032). With the median follow-up of 62 months, 5-year disease-free survival rates of the micrometastses negative and positive cases were 81.7 percent and 61.3 percent, respectively (p=0.0438).
CONCLUSIONS
In conclusion, immunohistochemical technique to identify the occult micrometastases in lymph nodes overlooked in conventional histopathology is a useful staging method to anticipate a recurrence and a prognosis more precisely.

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