Robotic-assisted Low Anterior Resection with Transanal Transection and Single-Stapled Anastomosis of an Early Rectal Adenocarcinoma: A Case Report
Autores
Catarina Palma, Carlota Branco, Constança Marques, João Velho Correia, Susana Ourô, Paulo Roquete, Jorge Paulino, Rui Maio
Resumo Introdução
Early rectal adenocarcinomas can often be managed with minimally invasive, organ-preserving strategies. Optimal outcomes depend on accurate staging and the integration of advanced surgical techniques such as robotic-assisted resection.
Resumo Métodos
An 89-year-old male (PS ECOG 0) with diabetes, hypertension, BPH, and atrial fibrillation presented with hematochezia after starting apixaban. Colonoscopy identified a flat rectal lesion (IIa + IIc, NICE 3, 15 mm) 9 cm from the anal verge. Biopsy revealed low-grade adenocarcinoma, staged as mrT0/1 N0 EMVI? M0. The patient underwent endoscopic intermuscular resection with en bloc removal.
Resumo Resultados
Histopathology showed a moderately differentiated adenocarcinoma with submucosal invasion (Kikuchi sm2/3), lymphovascular invasion, and intermediate tumor budding, with clear margins. A robotic-assisted low anterior resection with transanal transection and single-stapled anastomosis was subsequently performed. Final pathology revealed a millimetric intramucosal carcinoma focus (pT1 N0). The postoperative course was uneventful, and the patient remains disease-free after six months.
Resumo Discussão
Robotic surgery offers superior precision, dexterity, and visualization, decreasing LARS and overall complication rates. The transanal transection ensures adequate distal margin control, while the single-stapled anastomosis reduces tension and leakage risk. This stepwise, minimally invasive approach achieved complete oncologic resection and preserved functional outcomes.