# Feasibility and outcomes of robotic sphincter-preserving surgery for rectal cancer after neoadjuvant treatment in patients with preexisting colostomy

## TL;DR

This study examines robotic surgery for rectal cancer patients with or without a stoma after neoadjuvant treatment, finding it is safe and effective despite longer console time in stoma patients.

## Contribution

The study evaluates the feasibility and outcomes of robotic sphincter-preserving surgery in patients with a preexisting colostomy after neoadjuvant treatment.

## Key findings

- Patients with a stoma had longer console time but similar total operative time and blood loss compared to those without a stoma.
- Postoperative complication rates, anorectal function, and oncological outcomes were similar between groups.
- Robotic surgery was found to be safe and feasible for patients with a preexisting stoma after neoadjuvant treatment.

## Abstract

Diverting colostomy followed by neoadjuvant treatment is a treatment of choice for obstructive rectal cancer. Such patients may be treated via a robotic approach with several advantages over conventional laparoscopic surgery. Conversely, the existing stoma may interfere with the optimal trocar position and thus affect the quality of robotic surgery. Moreover, the console surgeon does not face the patient, which may endanger the stoma.

Patients with rectal cancer who underwent sphincter-preserving surgery were retrospectively investigated using a robotic platform after neoadjuvant treatment at our hospital. Based on pretreatment stoma creation, patients were divided into the NS (those without a stoma) and S groups (patients with a stoma). Baseline characteristics, types of neoadjuvant treatment, short-term surgical outcomes, postoperative anorectal manometric data, and survival were compared between the groups.

The NS and S groups comprised 65 and 9 patients, respectively. Conversion to laparotomy was required in three patients in the NS group. The S group required a longer console time than the NS group (median: 367 vs. 253 min, respectively, p = 0.038); however, no difference was observed in the total operative time (p = 0.15) and blood loss (p = 0.70). Postoperative complication rates, anorectal function, and oncological outcomes were similar between the groups.

Although console time was longer in patients with a stoma, robotic surgery could be performed safely like in those without a stoma after neoadjuvant treatment.