Locally advanced rectal cancer – surgical challenge

Abstract

Introduction: Locally advanced rectal tumours are usually treated with neo‐adjuvant therapy followed by resection. In our video titled ‘Locally Advanced Rectal Cancer – Surgical challenge’, we demonstrate a case of locally advanced tumour that did not respond well to neo‐adjuvant therapy. We showcased how dexterity in surgical skills with aid of robotic surgery helped achieve complete and precise resection of the rectal tumour. Our patient was a 72‐year‐old male with a locally advanced rectal cancer, Magnetic‐Resonance Imaging showed tumour ingrowth to mesorectum, close to mesorectal fascia. Neo‐adjuvant therapy did not achieve optimal tumour shrinkage, with tumour tethering to the mesorectal fascia and persistent mesorectal lymph nodes. Robotic low anterior resection of rectum was performed with good margins. Outline of video: We first introduced the clinical scenario and imaging of the patient. Then we showed the intraoperative video of robot‐assisted low anterior resection of rectum, in which the operating surgeon demonstrated dexterity in surgical skills when dissecting along the avascular planes, with the aid of robotic surgery. Histological examination of the specimen showed a grade pT3 rectal tumour with clear circumferential resection margin 8mm from tumour front. Proximal, distal and serosal margins are also clear. Four out of nineteen lymph nodes resected are positive. Overall cancer staging was ypT3N2 according to the American Joint Committee on Cancer (eighth edition). The patient had a smooth recovery and was discharged on post‐operative day 4. Learning objectives and conclusion: Locally advanced rectal tumours pose surgical and oncological challenge. Neo‐adjuvant therapy may not achieve satisfactory tumour shrinkage in locally advanced rectal cancer, in which surgery then plays an important role in treating the disease. Surgical dexterity and robotic surgery play important roles in rectal tumour resection, as showcased in the video.