Macroscopic Assessment of Total Mesorectal Excision Quality after Robotic Assisted Rectal Resection for Rectal Cancer in Bulgaria: A Prospective Trial

Dobromir D. Dimitrov 1 , Tsvetomir M. Ivanov 1 , Tashko S. Deliyski 1 , Sergey D. Iliev 2 , Emil T. Filipov 2 , Martin P. Karamanliev 1 , Tatqna M. Betova 3 , Savelina L. Popovska 3 , Nataliya P. Chilingirova 1 , Izabela P. Georgieva 1 , Slavcho T. Tomov 4  und Grigor A. Gortchev 4
  • 1 Division of Oncological Surgery, Bulgaria
  • 2 Department of Propedeutics of Surgical Diseases, Bulgaria
  • 3 Department of General and Clinical Pathology, Bulgaria
  • 4 Division of Gynecological Oncology, Bulgaria


Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robotic surgery has the potential to minimize the disadvantages of laparoscopic rectal resection. Circumferential margin and macroscopic quality assessment of the resected specimen are the major prognostic factors for local recurrence of the disease. The aim of this study was to research the macroscopic assessment of the quality of TME after robotic-assisted rectal resections for rectal cancer performed in a single center. Data was prospectively collected about macroscopic assessment of the quality of TME in thirteen patients after robotic-assisted rectal resections for rectal cancer between 09.04.2014 and 31.12.2016. After all robotic TMEs, a pathologist made macroscopic assessment of the completeness of the mesorectal excision. The quality of TME was complete in 12 cases and nearly complete in one case. The circumferential and distal resection margins were negative in all cases. The mean number of harvested lymph nodes was nine. This study indicated that using robotic surgery for rectal cancer does not lead to worsening the quality of TME. Further studies in this field are necessary.

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