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Page 10 of 12 Chen et al. Mini-invasive Surg 2018;2:43 I http://dx.doi.org/10.20517/2574-1225.2018.42

Table 5. Comparison of short-term oncological outcomes of robotic-assisted total mesorectal excision
Local recurrence Distant Disease-free Overall
Study Country (year) (%) metastasis (%) survival survival
Present study (low-lying rectum) Taiwan (2018) 3.5 8.8 88.3% (2-year) 96.7% (2-year)
Pai et al. [29] (all rectum) USA (2015) 4 17 79.2% (3-year) 90.1% (3-year)
Kim et al. [30] (all rectum) Korea (2016) 1.9 26.4 72.8% (4-year) 87.7% (4-year)
[31]
Feroci et al. (mid and low-lying rectum) Italy (2016) 1.9 17 79.2% (3-year) 90.2% (3-year)
Cho et al. [32] (all rectum) Korea (2012) 1.8 12.2 81.8% (5-year) 92.2% (5-year)
Park et al. [33] (all rectum) Korea (2015) 2.3 12.0 81.9% (5-year) 92.8% (5-year)
Ghezzi et al. [34] (low-lying rectum) Brazil/Italy (2014) 3.2 18.5 73.2% (5-year) 85.2% (5-year)
Hara et al. [35] (all rectum) Korea (2014) 4.5 10 81.7% (5-year) 92.0% (5-year)
Baik et al. [36] (all rectum) Korea (2013) 3.6 17.6 79.2% (3-year) 93.1% (3-year)
Abdel-Gawad et al. [42] (low-lying rectum) Egypt (2014) 14.8 14.4 82.6% (3-year) 88.7% (3-year)

Table 6. Comparison of short-term oncological outcomes of low-lying rectal cancer
Local Distant Surgery Surgery Surgery
Study Country (year) recurrence metastasis Disease-free Overall method: method: method:
(%) (%) survival survival open (%) laparoscopic robotic
(%) (%)
Present study Taiwan (2018) 3.5 8.8 88.3% (2-year) 96.7% (2-year) 0% 0% 100%
Ghezzi et al. [34] Brazil/Italy (2014) 3.2 18.5 73.2% (5-year) 85.2% (5-year) 37.3% 0% 62.7%
Abdel-Gawad et al. [42] Egypt (2014) 14.8 14.4 82.6% (3-year) 88.7% (3-year) NA NA 0%
NA: not applicable

was performed first, followed by robotic ISR 203 days later. Pathology reports showed that both CRM and
DRM were positive. During follow up period, she was still alive 2 years after operation.

In our study, none of the surgical procedures were converted to open or laparoscopic surgery. Studies
have shown that advanced local cancer stage, bulky tumors, and high body mass index may be respon-
sible for conversions [14,23,31,38] . Although our study consisted of some difficult cases, including large tumors
(4 patients with a tumor size > 5 cm), low-lying rectal cancer (distance of 3.5 cm from the anal verge), a
greater proportion of men (36 patients), and more challenging operation requirements (37 patients with
intersphincteric dissection), our morbidity results appeared promising. The anastomosis leakage rate in our
study is 3.3%, which is slightly lower than that in other studies [Table 4].

This study had some limitations. First, this was a single-institution retrospective study consisting of only
60 patients. Second, the follow-up interval was short, with a median follow-up duration of 28 months;
thus, only short-term (2-year) survival and oncological outcomes are reported. Nevertheless, the 2-year
overall survival (96.7%) and disease-free survival (88.3%) in our study were consistent with those reported
in previous studies [Table 5]. We also compared the short-term ontological outcomes of low-lying rectal cancer
[Table 6]. Third, we did not evaluate the postoperative outcomes with regard to urinary and sexual functions.

In conclusion, through comparison of short-term clinical outcomes, we have demonstrated that the robotic
TME technique is safe and feasible for patients with low-lying rectal cancer. Moreover, combining this ap-
proach with appropriate preoperative CCRT can deliver favorable short-term oncological outcomes. How-
ever, further investigation of long-term oncological outcomes is required using studies with longer follow-
up durations.

DECLARATIONS
Authors’ contributions
Conception and design of the study, Data analysis and interpretation: Chen PJ, Huang CW, Tsai HL, Yeh
YS, Wang JY