ONCOLOGICAL TRANSABDOMINAL AND TRANSANAL RECTOSIGMOIDECTOMY VIA ROBOTIC-ASSISTED SURGERY

Cases Presentation First case: A 54-year-old male patient with low rectal adenocarcinoma located 3 cm from the anal verge, classified as cT2 cN2a cM0, underwent neoadjuvant therapy according to the RAPIDO TRIAL protocol. Upon follow-up evaluation, the lesion remained infiltrative and hardened, starting 4 cm from the anal verge and extending 4 cm cephalically. He underwent robotic-assisted transanal and transabdominal rectosigmoidectomy, with specimen removal via the anterior abdominal wall, colorectal anastomosis 2 cm from the anal verge stapled endoanal, and loop transverse colostomy on the left flank. Postoperatively, he experienced partial anastomotic dehiscence with retro-rectal abscess formation. Surgical drainage was performed via endoluminal access on postoperative day 24. Following this, he had a good clinical recovery with no evidence of surgical complications or disease recurrence during the 3-month follow-up. Second case: A 63-year-old male with a history of mid-rectal adenocarcinoma, located 7 cm from the anal verge, initially underwent transanal resection of the lesion (TAR). Due to pT3 stage disease, preoperative MRI showed evidence of lymph node involvement in the mesorectum, and post-TAR imaging revealed pre-sacral lymphadenopathy. Chemoradiotherapy with radiosensitizing agents was initiated. During the second year of clinical-radiological follow-up, local recurrence was observed, and total mesorectal excision was indicated. The patient underwent robotic-assisted transanal and transabdominal rectosigmoidectomy, with specimen removal via transanal approach, mechanical colorectal anastomosis, and loop transverse colostomy, without complications. The patient is currently under outpatient follow-up with no evidence of surgical complications or neoplastic recurrence.

Discussion Post-neoadjuvant middle rectal tumors often require a combined transabdominal and transanal approach to achieve resection and low anastomosis with a protective stoma. In these cases, we show the use of robotic surgery for the abdominal component and the use of a proctoscope developed in our service for the anal component, which easily accesses this type of patient.

Conclusion Transabdominal and transanal resection is an effective therapeutic option for post-neoadjuvant middle rectal tumors with low colorectal anastomosis, and robotic surgery may be a good option for the abdominal component.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025