ozeki shinji

When performing anterior resection for rectal cancer, a robotic technique that provides three-dimensional visualization and technical dexterity has been applied to overcome some limitations of conventional laparoscopic surgery. As of the end of March 2013, 56 patients have undergone robotic colorectal surgery at Fujita Health University. We herein introduce our fully-robotic technique with single cart position and report short-term outcomes concerning 43 cases of rectal cancer. The current status and problems regarding robotic surgery for colorectal cancer in the literature are also described. Although robotic surgery for colorectal cancer has been safe and feasible, the long operative time should be shortened by utilizing the learning-curve effect.

We studied the clinicopathological characteristics of colorectal cancer with perforation in comparison with non-perforation cases, and treatment strategy for colorectal cancer with perforation. T4 cancers and cancers with massive venous invasion fell significantly into the perforation than the non-perforation group. Stage IV caner was seen more in cases with perforation than in non-perforation cases (p=0.08). The perforation occurred at the tumor site in 7 patients, at the oral site of cancer in 7, and at the anal site in 1. One-staged curative resection was performed in 5 patients, and two-staged curative resection was performed in 4. The operative time was longer, and blood loss during curative resection was more in the two-staged than in the one-staged resections. Recurrence occurred in 1 patient with stage II cancer, and in 3 patients with stage IIIa cancer. These four patients with recurrence after curative surgery had peritoneal or subcutaneous dissemination, accompanying cancer spread due to large bowel perforation. However, hematogenous or lymphatic recurrence was also seen in 4 patients including one patient who underwent a curability B resection. More lymph node dissections were seen in non-recurrence cases after curative resection (average: 19.8) than in recurrence cases (average: 6.3). It was believed that primary resection and proper lymph node dissection contributed to prevention of hematogenous or lymphatic recurrence and improvement of prognosis for the patients with large bowel perforation related to colorectal cancer.