176P - Robotic anterior resection of rectal cancer without abdominal incision: transanal rectal eversion and resection for specimen extraction: A prelimin...

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Rectal Cancer
Surgical Oncology
Presenter Dexiang Zhu
Citation Annals of Oncology (2016) 27 (suppl_9): ix53-ix67. 10.1093/annonc/mdw581
Authors D. Zhu, Z. Niu, Y. Wei, J. Xu
  • Department Of Colorectal Surgery, Zhongshan Hospital, Fudan University, 200032 - Shanghai/CN



The combination of robotic surgery and natural orifice specimen extraction (NOSE) for rectal cancer is scarcely investigated. The aim of this study was to indentify the benefits of robotic resection using a novel approach: transanal rectal eversion and resection for specimen extraction (Robotic TRERSE).


There were totally 26 patients who underwent Robotic TRERSE between Oct. 2013 and June. 2016 at Zhongshan Hospital, Fudan University. The distal rectum coupled with the lesion was everted out of the anus, and the tumor was resected with a sufficient margin above the dentate line under direct sight. Inclusion criteria includes tumor size (≤5cm), localization (≤10cm from anal), the lumen (≤ 2/3 circle), BMI (


There was no conversion. The maximum diameter of rectal lesions was 2.8±1.1cm, and distance of the lower edge from the anal verge was 7.7±2.2 cm. The operating time was 176.4±49.5 min, and blood loss was 101.1±43.1 ml. Moreover, there were 13.7±6.4 lymph nodes dissected, and length of distal margin was 2.1±0.8cm. Postoperative first flatus and resumed liquid diet was 2.1±0.6 days and 6.5±0.9 days. Postoperative hospital stay was about 8.7±4.4 days, while 3 patients developed anastomotic leakage, and managed with conservative treatment. During short-term follow-up period, there is no abdominal infection, pelvic abscess and other severe infectious complication for bacteriological outcome. For functional outcome, no dysuria, sexual function disorder and fecal incontinence were found. Importantly, none were observed local or distant metastasis, and no cancer-related death.


Robotic anterior resection of rectal cancer without abdominal incision, using transanal rectal eversion and resection for specimen retrieval, is safe and feasible. This technique requires no traditional abdominal incision with minimal invasiveness and excellent cosmetic effect, and long-term outcome of this surgery needs further investigation.

Clinical trial indentification


Legal entity responsible for the study

Department of Colorectal Surgery, Zhongshan Hospital, Fudan University


Zhongshan Hospital, Fudan University


All authors have declared no conflicts of interest.