Robot-assisted multivisceral resections for locally advanced rectal cancer: a case series and systematic review

Objective. To conduct a systematic review of literature data on robot-assisted multivisceral resections for locally advanced rectal cancer and to present own immediate results of these interventions. Material and methods. Request “robotic OR,” “robotic ORs,” “robot-assisted OR,” “robot-assisted” and «(Robotic OR robot-assisted) AND rectal AND (T4 OR multivisceral)» in PubMed and E-library databases resulted in 268 publications. Of these, 12 articles were included. Surgery time, intraoperative complications, including blood loss, conversion rate, postoperative complications, and extent of resection (R0, R1) were studied. Meta-analysis enrolled the incidence of complications and R0 resections. In addition, own results of 5 robot-assisted combined rectal resections for the period August — December 2024 are presented. Rectal resections were combined with bladder resection in three cases, and left-sided adnexectomy was performed in one case. One surgery was combined with anterior abdominal wall resection. Results. Treatment outcomes were analyzed in 891 people. The conversion rate was 11%, incidence of R0 resections — 76.2—100%, overall morbidity — 20.7—78%. Locoregional recurrences occurred in 4—9.3% of cases. Own results of treating 5 patients with locally advanced rectal cancer are summarized. There were R0 resections in all cases. There were no intraoperative complications. Severe postoperative complications (Clavien-Dindo ³ III) were observed in one case. Mean surgery time was 5 hours. Conclusion. Our experience of robot-assisted combined rectal resections for locally advanced cancer demonstrates feasibility of such operations. Own data are comparable with results of previous studies. Systematization of available results is complicated by high heterogeneity of data. However, available data are favorable and confirm the need for prospective accumulation of experience.