Colorectal cancer (CRC) is considered the 3rd most common cancer worldwide. In India, Rectal and colon cancer are considered the 9th and 8th most common cancers among men. While in women, colon cancer was ranked as the 9th most common cancer in a report by the Indian Council of Medical Research – the largest apex body for research in India. This translates to an annual incidence rate of 4.4 (colon cancer) and 4.1 (rectal cancer) per 1,00,000 Indian men and 3.9 per 1,00,000 in Indian women. Therefore, making colon cancers and rectal cancers significant concerns in India.
The risk factors for CRC can be divided into genetic and/or environmental or lifestyle-related factors. Most CRCs are sporadic, although genetic factors increase the risk considerably. For example, the Cancer Genome Atlas Network found a strong genetic between rectal and colon cancer disease. Research showed that there were 24 different genes that mutate to result in either rectal or colon cancer. This also provides the opportunity to effectively develop targeted medication to manage these illnesses. Familial genetic mutations constitute only about 5-10% of CRCs.
Since most patients present themselves with blood in stool, bowel disturbances or weakness a thorough evaluation is needed to confirm rectal cancer. Apart from the routine blood tests, tests for carcinoembryonic antigen (CEA) tests are done to measure the progress of treatment. The symptoms depend on the location of cancer within the colon. In addition, colonoscopy, and biopsy of the suspected sample is carried out. Therefore, treatment is usually considered through a multidisciplinary approach to ensure that all possibilities are considered for the patient’s benefit.
Abdominoperineal resection has typically been used to treat rectal malignancies (Surgery to remove the anus, the rectum, and part of the colon through an incision made in the abdomen). In such cases, the anus is removed and a permanent bag is put on the abdomen to collect the faeces. Despite initial reservations, laparoscopic colorectal surgery has gained acceptance and is now the standard of care for both benign and malignant colorectal illnesses in most parts of the world. However, the inherent difficulties of conventional laparoscopy limit laparoscopic colorectal surgery for difficult colorectal cancer surgeries. Two-dimensional (2-D) imaging (although 3-D platforms are becoming more available), an unstable assistant-dependent camera, poor ergonomics, straight fixed tip instruments, and an enhanced tremor effect are among them. These difficulties are exacerbated when operating in small spaces such as the pelvis, making laparoscopic rectal surgery particularly difficult. This is demonstrated by the low overall procedure volume, high conversion rates, and steep learning curve associated with laparoscopic rectal surgery. Because the traditional laparoscopic approach to rectal surgery has several limitations; many colorectal surgeons have great aspirations for the robotic surgical system as an alternative modality for overcoming laparoscopic surgery challenges and thus improving oncologic and functional outcomes. Saving the anus is possible in 80% of the cases with the latest technology and technique that is available to surgeons today.
In a case that involved a 65-year-old male patient with rectal cancer that was managed with chemotherapy and radiotherapy to reduce the size and was advised surgery to remove cancer along with the removal of his fully functional anal sphincter and a permanent bag for stool with the traditional method. This patient was very keen on saving his anus and avoiding a permanent stoma. Therefore Robotic intersphincteric resection (ISR) was suggested as the patient’s anal sphincter could be saved through this precise method using the latest daVinci surgical robot. Post-surgery, a temporary bag was placed for just 15 days to ensure complete healing of the anal area. Follow up review of the patient showed full recovery and return to everyday life.
Robotic-assisted surgery has made a significant difference in saving anal sphincters during colorectal cancer surgeries, followed by very good patient outcomes compared to the traditional approach.
