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Related Experiment Video

Updated: Oct 14, 2025

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Abdominoperineal Resection for Rectal Cancer: Open, Laparoscopic or Robotic Approach.

Daniel Gavrila, Ovidiu Bitere, Gabriela Droc

    Chirurgia (Bucharest, Romania : 1990)
    |November 9, 2021
    PubMed
    Summary

    Minimally invasive surgery (MIS) offers advantages for abdominoperineal resection (APR), reducing blood loss and postoperative complications compared to open surgery. Patient selection and surgical experience are key to successful MIS APR.

    Keywords:
    abdominoperinealresectionminimallyinvasivesurgeryrectalcancerroboticapproachtotalmesorectalexcision

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    Area of Science:

    • Colorectal Surgery
    • Surgical Oncology
    • Minimally Invasive Procedures

    Background:

    • Abdominoperineal resection (APR) is a critical procedure for low rectal and anal cancers.
    • Both open surgery (OS) and minimally invasive surgery (MIS) approaches exist for APR.
    • Surgical team experience in both OS and MIS is crucial for technique selection.

    Purpose of the Study:

    • To compare minimally invasive surgery (MIS) versus open surgery (OS) for abdominoperineal resection (APR).
    • To evaluate preoperative selection criteria, intraoperative, and early postoperative outcomes.
    • To identify the optimal surgical approach for experienced surgical teams.

    Main Methods:

    • Retrospective study of 233 patients undergoing APR for low rectal or anal cancer (2008-2020).
    • Patients divided into MIS (laparoscopic and robotic) and OS groups.
    • Analysis of perioperative characteristics to determine optimal approach and selection criteria.

    Main Results:

    • Open surgery group had more patients with prior abdominal surgery (p = .0002).
    • MIS group showed significantly lower intraoperative blood loss (p = .02) and postoperative morbidity (p = .005).
    • Mortality occurred only in the OS group (3 cases) among patients with severe comorbidities; MIS group had more T2 stage patients (p= .037).

    Conclusions:

    • Minimally invasive surgery (MIS) offers advantages for abdominoperineal resection (APR), including avoiding an extra incision.
    • Successful MIS APR relies on careful preoperative patient selection and experienced surgical teams.
    • Robotic APR demonstrated technical superiority with no conversions, unlike laparoscopic approaches.