EP469 - Intermediate Oncologic Outcomes in Rectal Cancer with the SP Robot: Is it safe? Yes or No?

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Purpose/Background: The adoption of new approaches requires careful evaluation to assure that they are both safe and effective. As the single-port (SP) robot becomes widely available for colorectal procedures, its ability to effectively resect rectal cancer becomes increasingly important. We analyze our oncologic outcomes performing sphincter preservation surgery for rectal cancer with the SP robot in patients with two-year follow up and present them here.

Methods/Interventions: A prospectively maintained database with IRB approval was queried to find patients who were operated on with the SP robot for rectal cancer. All consecutive patients from the 10/2018 to 9/2022 were enrolled allowing for 24-month follow up time. Primary outcomes for the overall group and subgroup of transanal and radical resection were analyzed for local recurrence, disease status, morbidity and mortality. Secondary outcomes of estimated blood loss (EBL), length of stay (LOS), conversion, margin status, TME completions and nodal harvest are reported.

Results/Outcomes: Of 167 patients operated in the time period, 57 SP patients were identified; 17 underwent LE and 40 had radical sphincter-preserving surgery (SPS) with an average follow up of 35 months. There were 29 women, avg age of 60 years (37-83yr) and avg BMI of 28.12 kg/m2. ASA class was II (n=32) and III (n=24). Eighty-two percent of patients underwent neoadjuvant treatment. Average estimated blood loss was 112.4cc, no blood transfusions were required. Overall morbidity was 7% with 5.9% in the LE and 7.5% in the SPS groups respectively. Overall, average days to flatus is 1.8, days to BM is 1.9, days to liquid diet is 1.22, days to low residual diet is 2.9. and the length of stay is 5.1 days. Overall average follow up was 34.9 months, 32 months in the LE, 35.7 months in SPS. There were minor and major wound separations in the LE group. The minor 90-day morbidity for LE was 5.9%, the major 90-day morbidity in LE was 11.8%, and 13% in the SPS. There were no conversions to open in either group. There were no mortalities. T stage on presentation was as follows T1-10; T2-9; T3-34; T4-4. Pathology was as follows; complete response (28), T1-3, T2-15, T3-11. TME completeness was 97.5%, 2.5% near complete, amongst SP radical resections and all margins were negative across both groups (distal, proximal, and radial). Average lymph node harvest was 16.7 (range 5-40) in the SPS group. Local recurrence overall was 3.5%, in LE it was 5.9%, and in SPS it was 2.7%. Within the follow up interval, 86% of patients had no evidence of disease (NED).

Conclusion/Discussion: This data shows low local recurrence rates at 24 months for rectal cancers undergoing sphincter preservation surgery both abdominally and transanally with the SP robot. Longer follow-up and greater numbers will be needed to definitely address the role of the SP robot in TME and TAMIS. However, this first report of intermediate oncologic outcomes will the SP robot is encouraging.