Robotic‐assisted laparoscopic abdominoperineal resection for anal cancer: feasibility and technical considerations

Abstract

BACKGROUND: Robotic-assisted laparoscopic surgery is an emerging technology that may prove advantageous for complex colorectal procedures involving the irradiated pelvis, such as abdominoperineal resection for recurrent anal cancer. The authors' initial experience is presented, with assessment of feasibility, safety, and oncologic principles. METHODS: Over a 6 month period, five abdominoperineal resections were performed using the da Vinci® robot for recurrent anal cancer in patients initially treated with definitive chemoradiation therapy. Demographics, intraoperative parameters, pathology, and outcomes were assessed. RESULTS: Five patients underwent surgery with a mean age of 58.8 years and body mass index of 24.9 kg m(-2) . The interval between chemoradiation and salvage APR was 14.2 ± 10.0 months. Operative time was 204 ± 39.1 min with robotic docking time 12.2 ± 2.8 min and console time 93.0 ± 24.9 min. The mean estimated blood loss was 150 cc and there were no intraoperative complications. The mean hospital length of stay was 5.4 days. Pathology analysis revealed that all surgical margins were adequate. There was one postoperative complication consisting of a seroma. CONCLUSION: Robotic-assisted laparoscopic surgery for anal cancer was found to be a safe and feasible procedure. It facilitated enhanced visualization and dissection through deep irradiated pelvic structures.