The potential benefits of robotic-assisted compared with laparoscopic surgery for locally advanced cancer have not been sufficiently proven by prospective studies. One factor is speculated to be the lack of strict surgeon criteria. The aim of this study was to assess outcomes for robotic surgery in patients with locally advanced rectal cancer with strict surgeon experience criteria. A criterion was set requiring surgeons to have performed more than 40 robotically assisted operations for rectal cancer. Between March 2020 and May 2022, patients with rectal cancer (distance from the anal verge of 12 cm or less, cT2–T4a, cN0–N3, cM0, or cT1–T4a, cN1–N3, cM0) were registered. The primary endpoint was the rate positive circumferential resection margin (CRM) from the pathological specimen. Secondary endpoints were surgical outcomes, pathological results, postoperative complications, and longterm outcomes. Of the 321 registered patients, 303 were analysed, excluding 18 that were ineligible. At diagnosis: stage I (n = 68), stage II (n = 84) and stage III (n = 151). Neoadjuvant therapy was used in 56 patients. There were no conversions to open surgery. The median console time to rectal resection was 170 min, and the median blood loss was 5 ml. Fourteen patients had a positive CRM (4.6%). Grade III-IV postoperative complications were observed in 13 patients (4.3%). Robotic-assisted surgery is feasible for locally advanced rectal cancer when strict surgeon criteria are used.

INTRODUCTION: In high sacrectomy, it is difficult to secure the lateral surgical margin and prevent severe postoperative complications. In this report, we present our unique surgical procedure using transanal total mesorectal excision for locally recurrent rectal cancer. TECHNIQUE: A 49-year-old woman was diagnosed with locally rerecurrent rectal cancer, which was located at the height of the S3 vertebra by preoperative imaging, and posterior pelvic exenteration concomitant with high sacrectomy below the S2 vertebra was planned. A multiaccess transperineal platform was placed to secure the lateral surgical margin using transperineal minimally invasive surgery during the perineal and sacral side procedure. Transperineal minimally invasive surgery has several clinical benefits over the conventional approach. For the perineal approach, a 2-team laparoscopic approach was performed. This surgical intervention with laparoscopic perineal assistance contributed to the completion of the dissection of the planned lateral surgical margin, such as the distal piriformis muscles and the sacrotuberous and sacrospinous ligaments, which are the most difficult areas to access in the lithotomy position. Regarding the sacral approach, it facilitated the dissection of the dorsal space of the sacrum; therefore, only a 7-cm transverse skin incision was required during sacrectomy. Small skin incisions and minimal dissection may reduce surgical site infections. RESULTS: The operative time was 933 minutes, with 80 mL of blood loss. There were no major complications, and pathologically confirmed curative resection was achieved. CONCLUSIONS: Our new technique utilizing transanal total mesorectum excision is feasible to secure the lateral surgical margin with minimal skin incision and dissection and may prevent severe postoperative complications.

Central line-associated bloodstream infection (CLABSI) associated with implanted central venous (CV)-access ports (CV ports) remains one of the most serious complications that can worsen patient outcomes. Despite the importance of this problem, comprehensive reports are limited. Here we report an analysis of CLABSI risk factors in patients with CV ports at our institution. Data from patients who had CV ports placed between January 2018 and March 2023 were retrospectively collected and analyzed. The primary outcome was the incidence of CLABSI, which was determined based on the Japanese Healthcare Associated Infections Surveillance criteria. To identify independent risk factors for CLABSI, univariate and multivariate analyses were performed to investigate 19 factors, including sex, age, cancer carriage status, inflammatory bowel disease (IBD), and drugs administered through CV ports. Out of 867 patients with a CV port, CLABSI was observed in 117 patients (13.5 %), with an incidence of CLABSI of 0.45 per 1000 device-days (laboratory-confirmed bloodstream infection: 0.31, clinical sepsis: 0.14). Multivariate analysis identified IBD [Odds ratio (OR): 4.47, 95 % Confidence Interval (CI): 2.34-8.52] and the administration of lipid emulsions [OR: 4.28, 95 % CI: 2.01-9.13] as independent risk factors for CLABSI. Multivariate analysis for cancer patients identified the use of lipid emulsions (OR: 5.39, 95 % CI: 2.38-12.24) as an independent risk factor for CLABSI. Close monitoring is essential when patients with a CV port receive lipid emulsions. Placement of a CV port may be avoided in patients with a history of IBD if possible.