Rectal Cancer Surgery at Main Line Health
Pushing the Limits of Minimally Invasive Rectal Cancer Surgery
A colorectal surgery team at Lankenau Medical Center, part of Main Line Health, has reported encouraging results with a first-of-its-kind minimally invasive transanal approach to definitive surgical treatment of rectal cancer.
First reported rectal cancer surgeries using a state-of-the-art robotic platform
The surgical team, led by John Marks, MD, published its experience with the first two of a series of rectal cancer cases in a prospective study of a novel single-port robotic surgical platform the team is investigating for minimally invasive and transanal surgery across a range of colorectal disease (ClinicalTrials.gov Identifier: NCT03700593). Dr. Marks is the first colorectal surgeon in the world to report clinical experience with this new robotic surgical platform for transanal dissection of rectal cancer.
Both rectal cancer cases involved a preoperative stage T3N1 lesion in the lower third of the rectum, a notoriously difficult location in which to perform a precise, oncologically sound resection that is also sphinctersparing. In both cases, following protocol-directed neoadjuvant chemoradiotherapy, a total mesorectal excision (TME) was completed transanally using the new single-port robotic technology, without conversion or operative complications.
The two patients underwent surgery in December 2018 and January 2019, respectively, and received a 6-month course of adjuvant chemotherapy, after which their temporary ileostomies were reversed.
At an average of 22.5 months of follow-up, neither patient had experienced local recurrence or distant spread of their disease, morbidity or death.
For Dr. Marks, the early positive results are an encouraging sign of what is possible for patients with difficult-to-access rectal cancer. While the new single-port robotic technology is not yet approved by the U.S. Food and Drug Administration for colorectal applications, his published experience documents the feasibility and safety of single-port robotic transanal TME in experienced hands.
The challenge of performing a high-quality rectal cancer resection
Surgery plays a critical role in the care of patients with rectal cancer but is challenging to perform and poses a risk to sphincter function. A precise and complete TME is critical to achieve oncologic control and to reduce the rate of cancer recurrence.
Dr. Marks describes the new single-port robotic surgery platform as a “game-changer” for performing rectal cancer resections and says he believes it can bring quality rectal cancer resection within reach for more surgeons and more patients with rectal cancer.
“With its superior dexterity for precise work in the tight bony confines of the pelvis, it brings robotic surgery capabilities to anatomic areas you cannot get to any other way,” he explains. “Also, its excellent optics give us the ability to see and cut and sew better, and we've found that better for the surgeon is better for the patient.
“Finally,” he adds, “on top of this we can do these complex operations safely and effectively through a single 1-inch incision or no incision at all.”
Dr. Marks sees the emergence of new technology that has allowed him to transanally perform high-quality TME dissections as the culmination of a career of innovation. As he explains, a major focus of his professional career has been the marriage of optimal rectal cancer management with the highest possible quality of life--and the use of new technology to accomplish both.
A giant in the fields of minimally invasive colorectal surgery and rectal cancer management, Dr. Marks is committed to sharing knowledge gained through clinical investigations such as the study he and his Lankenau colleagues are conducting on colorectal applications of single-port robotic and transanal robotic surgery. In addition to the initial rectal cancer cases reported this month, the team previously reported its initial clinical experience with single-port robotic left colectomy, single-port robotic right colectomy, and transanal minimally invasive surgery for benign rectal neoplasms.
"We're focused on sharing what we've learned with others, so we all learn from each other and get better quickly for our patients,” says Dr. Marks.
JOHN MARKS, MD is Chief of Colorectal Surgery at Main Line Health and Director of the Rectal Cancer Program at Lankenau Medical Center, part of Main Line Health.
Dr. Marks leads Main Line Health’s multidisciplinary rectal cancer team at Lankenau Medical Center, which is among an elite group of international rectal cancer specialists currently working to define new pathways for improved outcomes in rectal cancer care. Main Line Health’s rectal cancer team has treated more than 1400 patients and frequently publishes findings from systematic follow-up in this patient population.