Robotic hemi-levator excision for low rectal cancer: A novel technique for sphincter preservation

摘要

Abstract Introduction Sphincter-saving procedures have been published as safe and feasible alternative approaches to radical abdominoperineal resection (APR). We considered that there is a subgroup of patients, between APR and intersphincter resection (ISR), in whom the sphincter could still be saved, without inferiority, in shortor longterm outcomes. Robotic hemi-levator excision is a new procedure based on the concept of saving the sphincter and improving the quality of life while providing oncological safety. This procedure is specific for tumours located at the level of the anorectal ring (levatorani); saving the sphincter at that level with a negative resection margin is challenging. We report our initial case experience, including the principles of the technique, its indication as well as safety and feasibility. Methodology This technique was performed prospectively in two selected patients at Yonsei University health system, South Korea. Selection criteria, technical tips, pathological reports and follow-ups have been prospectively reported. Hemi-levator excision was performed on two male patients with ages of 52 and 70 years and tumour levels at 4 and 5 cm from anal verge, respectively. No residual tumour has been reported in the first case and safe margins were reported in the second one. Discussion The hemi-levator excision technique is a novel sphincter-preserving technique that can be used in select patients. It is safe and feasible in selected cases. However, long-term functional and oncological outcomes still need to be assessed.