Robot-assisted antegrade intersphincteric resection: A case from practice at the Moscow City Oncology Hospital No. 62

Background. Treatment of low tumors of the rectum remains one of the most complex oncological problems. If a tumor is ultra-low and specific anatomical characteristics of the pelvis are identified, organ-sparing surgery in the framework of the standard laparoscopic access becomes exacting due to rigidity of the instruments, while combined abdominoperineal resection is associated with additional risks. In robot-assisted access, the instruments have much higher motion degrees of freedom which allows to overcome difficulties caused by complex anatomy, size and site of the tumor.

Aim. To demonstrate benefits of organ-sparing robot-assisted antegrade intersphincteric resection in patients with narrow and deep pelvis using a real clinical case.

Clinical case. A 50‑year-old patient was admitted to the Oncological Proctology Division of the Moscow City Oncology Hospital No. 62 with adenocarcinoma of the lower rectal ampulla (cT3N1M0). Magnetic resonance imaging showed features of the pelvis making standard intervention difficult. Following neoadjuvant chemoradiotherapy without a significant pathological response, a fully transabdominal robot-assisted (da Vinci Xi) intersphincteric rectal resection was performed. Distinctive features of the procedure were absence of the perineal stage, colonic pull-through and delayed (on day 7) coloanal anastomosis formation without a temporary stoma. This technique allowed the avoid extirpation while achieving oncological radicality (ypT3N0R0). Functional outcomes at 6 months corresponded to a Wexner score of 12.

Conclusion. This approach, based on strict magnetic resonance imaging data on the features of the pelvis allows to spare the anal sphincter preservation in patients with ultra-low tumors in the setting of challenging pelvic anatomy.

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