SP3.3 - Real World Experience of 600+ Minimally Invasive Abdominoperineal Resections (APR) Done for Low Rectal Cancers in Tertiary Cancer Care Center

Abstract Introduction APR is standard of care surgery for low rectal cancers involving sphincter. Surgery is commonly done in minimally invasive way. Robotic surgery has recently gained popularity due to ease of procedure. Margin positivity and local recurrence still remain a challenge. Methods It is a retrospective study from prospectively maintained database from Aug 2013 to Aug 2023. Surgical and oncological outcome were analyzed using SPSS version 25 software. Results Total 657 minimally invasive APRs were done. All were done in supine lithotomy position. 570 were laparoscopic and 87 robotic. Mean age was 48.4 years. 6 cases were converted to open (5 lap and 1 robotic). Mean BMI was 22.3. Mean distance from anal verge was 3 cm. Majority patients were cT3 (74%). Median blood loss was 150 ml. Clavien Dindo grade III and beyond complications were seen in 11.2%. Mean hospital stay was 7 days. Mean nodes harvested were 13. Mean no of positive nodes were 1.22. Extended resections (extended TME) were 25% in lap and 42% in robotic. Poorly differentiated and signet histology was seen in 27%. CRM positivity was 6.9%. It increases to 15.5% in signet ring histology. Median follow up achieved was 46 months. Local recurrence was 5.5%. Distant recurrence was 20%. 3-year OS and DFS were 73% and 63% respectively. Conclusion In high volume minimally invasive surgery centre, MIS abdominoperineal resection - both laparoscopic and robotic has acceptable surgical and oncological outcomes.