Robotic Multivisceral Resection (RMVR) of the Pelvis for Locally Advanced Colorectal Carcinoma: Single Oncosurgical Center Experience.

Introduction: Locally advanced colorectal cancer management remains a challenge due to multiple reasons. Some of the major ones include the changes following the use of neoadjuvant radiotherapy and systemic anticancer treatment and previous abdominal surgery (including defunctioning stoma and related changes) and the proximity of structures close to the cancer. Robotic colorectal surgery for malignancy is rapidly evolving as a surgical technique in the management of colorectal cancers but its role in the management of locally advanced disease is not defined. Methods: This is a retrospective analysis of robotic colorectal surgery performed and captured in a prospective database. Patients who underwent multivisceral robotic colorectal surgery from 2012 to 2022 were included in this study. Robotic colorectal surgeries without multivisceral resections were excluded. Results: A total of 24 patients underwent robotic multivisceral resection (RMVR). This included 6 males and 17 females. The 17 females underwent posterior clearance, 5 males underwent abdominoperineal resection with seminal vesicle excision, and 1 male underwent total pelvic exenteration. Of the patients, 22 had neoadjuvant pelvic radiotherapy. Sixteen (66.7%) had past lower abdominal surgery (stoma). Preoperative tumor staging was T3 or T4 in 90%, and 80% had R0 resection. The median lymph node harvest was 15 (range 4-31). There was zero need for conversion to open surgery and zero 90-day mortality. Conclusion: RMVR is a safe approach for locally advanced colorectal cancer, with acceptable surgical clearance.