Complications associated with ultra-low anastomosis after robotic intersphincteric resection for low rectal cancer

• Main Authors: LIU Hongchang, WANG Xiaosong, GAO Linfeng, ZHANG Chao, LUO Huaxing
• Format: Article
• Language: zho
• Published: Editorial Office of Journal of Third Military Medical University 2019-09-01
• Series: Di-san junyi daxue xuebao
• Subjects: ultra-low rectal cancer; complications; intersphincteric resection; robotic surgery
• Online Access: http://aammt.tmmu.edu.cn/Upload/rhtml/201906022.htm

Objective To investigate the complications associated with ultra-low anastomosis in robotic intersphincteric resection for rectal cancer and analyze their clinical characteristics for their prevention and treatment. Methods We retrospectively analyzed the clinical data of 43 patients undergoing robotic intersphincteric resection for low rectal cancer in our hospital between January, 2015 and March, 2019. The patients were followed up after the surgeries via outpatient visit and by telephone to assess the occurrence of anal stenosis, edematous hemorrhoids, partial intestinal obstruction, rectovaginal fistula, anastomotic leakage, and rectal mucosal prolapse. The surgical and perioperative data including intraoperative blood loss, operative time, defecation time, time to normal diet, postoperative hospital stay, postoperative pathology, the number of lymph nodes involved, and distal resection margin were also analyzed for the patients. Results All the patients underwent robotic intersphincteric resection and prophylactic ileostomy. Postoperative anal stenosis (mainly membranous stenosis) was found in 19 patients (44.2%) after the surgery, and was relieved by regular anal expansion. Postoperative edematous hemorrhoids were found in 14 patients (32.6%) and remitted at a median of 33 d (range 16-64 d) after the operation. Among the 10 patients with partial intestinal obstruction, 1 patient underwent closure of ileostomy 35 d after operation, which was before the scheduled time; and in the remaining patients, ileostomy was closed by elective surgery after conservative treatment. Two patients experienced anastomotic leakage and 1 patient had rectovaginal fistula after the surgery (delayed fistula). No rectal prolapse occurred in these patients. Univariate logistic regression analysis showed that the male gender was an independent risk factor for anal stenosis (P=0.002), and the incidence of edematous hemorrhoids was correlated with the operation time (P=0.005). Conclusion Anal stenosis, edematous hemorrhoids, and partial intestinal obstruction are the most common complications associated with ultra-low anastomosis after robotic intersphincteric resection surgery for rectal cancer, and early preventive measures and active interventions can achieve favorable outcomes.