Rectal cancer, a prevalent form of colorectal cancer, poses significant challenges to surgeons due to its location in the pelvis and the need for precise removal of the tumor while preserving essential structures. Over the years, advancements in surgical techniques have transformed how rectal cancer is treated, with robotic-assisted surgery (RAS) emerging as a promising alternative to traditional open and laparoscopic approaches.

A recent landmark study conducted by the Indian Collaborative Group on Rectal Resections (ICGRR) has shed light on the outcomes of open, laparoscopic, and robotic-assisted rectal resections in the Indian healthcare context. This study, the largest of its kind in India, analyzed data from 829 patients across 11 centers and provides valuable insights into the short-term outcomes of these surgical techniques. As a contributor to this study, I, Dr. Sandeep Nayak, operated on many of these cases at Fortis Hospital, Bangalore. Here, I share key findings and discuss the broader implications of robotic-assisted surgery in rectal cancer care.

Rectal cancer arises in the rectum, the last segment of the large intestine. Its treatment often involves surgical resection following the principles of Total Mesorectal Excision (TME), which ensures the removal of the tumor and surrounding tissues to prevent recurrence. However, the rectum’s narrow location in the pelvis makes surgery particularly challenging. Surgeons must navigate intricate anatomy, protect critical nerves and blood vessels, and achieve clear margins to ensure the cancer is removed completely.

For decades, open surgery, which involves a large incision, was the standard approach. However, it often resulted in significant blood loss, longer recovery times, and higher complication rates. The advent of laparoscopic surgery, a minimally invasive technique using small incisions and a camera, addressed some of these challenges but had its own limitations, such as restricted visibility and reduced instrument maneuverability in the narrow pelvic cavity.

Robotic-assisted surgery (RAS) has emerged as a transformative advancement, combining the benefits of minimally invasive techniques with cutting-edge technology. With enhanced precision, 3D visualization, and superior instrument dexterity, robotic surgery allows surgeons to operate more effectively in confined spaces like the pelvis.

1. Shorter Hospital Stays:

• Patients in the RAS group had the shortest average hospital stay (7.8 days), compared to the LG (10.3 days) and OG (14 days) groups.
• At experienced centers like ours, where both robotic and laparoscopic surgeries are performed in high volumes, the average hospital stay for both approaches is approximately 4 days, reflecting the importance of expertise in achieving optimal outcomes.




2. Reduced Blood Loss and Complications:
• Robotic-assisted surgery resulted in significantly less blood loss compared to laparoscopic and open surgeries, reducing the need for transfusions and associated risks.
• Postoperative complications were lowest in the RAS group (13.7%) compared to LG (19.9%) and OG (36.6%).
  
  
  3. Better Surgical Precision:
• The RAS group had the lowest rate of positive circumferential resection margins (CRM)—a critical measure of how completely the tumor was removed—at 87%, compared to 6.8%in LG and 26.5% in OG.




4. Early Start of Adjuvant Therapy:
• Patients in the RAS group could begin adjuvant treatments like chemotherapy sooner (median 24.5 days) than those in LG (31 days) and OG (32.5 days). Early initiation of therapy is linked to better long-term outcomes.




5. Longer Operating Times:
• Robotic surgeries took longer to perform (average 326 minutes) than laparoscopic (287 minutes) and open surgeries (256 minutes). This is largely due to the time required for robotic system setup and docking.

One of the key insights from this study is the skill-dependent nature of surgery. While robotic-assisted surgery offers advanced technology that enhances precision and efficiency, its success relies heavily on the expertise of the surgeon and the surgical team.

At high-volume centers like Fortis Hospital, Bangalore, where I performed many of the robotic and laparoscopic surgeries included in this study, both techniques yield comparable outcomes in terms of hospital stay and recovery time, with most patients being discharged within four days. However, this is not uniform across all centers. The ICGRR study involved 11 hospitals, each with varying levels of expertise and case volumes. Not all centers performed both laparoscopic and robotic surgeries in high volumes, and this variability impacts the generalizability of the study’s findings.

The study highlights that while robotic surgery offers significant advantages, outcomes are closely tied to the experience and proficiency of the surgical team. Centers with extensive experience in robotic and laparoscopic techniques tend to achieve better results, whereas centers with limited experience may face challenges in replicating these outcomes.

Robotic-assisted surgery is a valuable tool in the treatment of rectal cancer, offering several advantages:

• Enhanced precision and visualization, particularly in complex pelvic anatomy.
• Reduced blood loss, postoperative complications, and shorter hospital stays.
• Improved ability to achieve clear margins, reducing the risk of recurrence.

However, robotic surgery also has limitations:

• Cost: Robotic systems are expensive, which may limit their accessibility for patients in some regions.
• Learning Curve: Surgeons require extensive training and experience to fully harness the benefits of robotic technology.
• Longer Operating Times: As seen in this study, robotic surgeries often take longer than laparoscopic or open surgeries, though this improves with experience.

The ICGRR study is a landmark effort in Indian healthcare, involving data from 11 centers and 829 patients. This collaboration between public and private institutions provides a comprehensive overview of real-world outcomes for rectal cancer surgery in India.

As a contributor to this study, I had the privilege of performing many of the robotic and laparoscopic surgeries at Fortis Hospital, Bangalore. My contribution reflects the importance of high-volume centers and skilled teams in achieving the best outcomes for patients.

The ICGRR study is a landmark effort in Indian healthcare, involving data from 11 centers and 829 patients. This collaboration between public and private institutions provides a comprehensive overview of real-world outcomes for rectal cancer surgery in India.

As a contributor to this study, I had the privilege of performing many of the robotic and laparoscopic surgeries at Fortis Hospital, Bangalore. My contribution reflects the importance of high-volume centers and skilled teams in achieving the best outcomes for patients.

Link to paper: https://link.springer.com/article/10.1007/s11701-025-02375-5

Hysterectomy is the surgical removal of the uterus. It’s a standard procedure to treat various conditions affecting a woman’s reproductive system. Even after such a definitive procedure, the possibility of developing cancers, such as vaginal cancer, still exists.  

Dr. Sandeep Nayak, an accomplished oncologist in Bangalore, explains:

“Hysterectomy is also performed to address malignant or premalignant diseases of the cervix. But, vaginal cancer after hysterectomy, though rare, can still occur. This is because cells in the remaining vaginal tissue can still undergo harmful changes. If left untreated, it can lead to cancerous growth. This underscores the importance of ongoing vigilance and awareness post-surgery.”

Join us as we delve into the warning signs, stages, and challenges linked with vaginal cancer. Additionally, we will discuss the available treatment options and their implications for patients.

Recognizing warning signs of cancer can lead to early detection and better outcomes. Let’s delve into understanding our body’s signals to alert us.

Vaginal cancer demands attention and awareness. Here’s what to watch out for, regardless of whether you’ve undergone hysterectomy or not:

Bleeding after menopause or unusual bleeding between periods warrants prompt attention. Also, pay attention to any bleeding during or after sexual intercourse.

Persistent discharge unrelated to menstruation or infection can indicate vaginal cancer. A sudden change in vaginal discharge may signal a problem, particularly if it becomes:

• Watery
• Bloody
• Foul-smelling

Don’t ignore persistent pelvic pain, often described as a constant ache or pressure. Pain during urination or bowel movements may also signal underlying issues.

Discomfort or pain during sexual intercourse, unrelated to lubrication or emotional factors, merits attention.

Feeling a lump inside the vagina is a direct indication of something abnormal needing prompt attention.

Persistent pain in the lower back, hips, or legs, unrelated to other conditions or injuries may indicate advanced vaginal cancer. Cancer can cause pain due to pressure from a tumor or as a result of cancer spread.

From the initial stages to advanced progression, understanding the stages of vaginal cancer is crucial. Let’s look at each stage to gain insights and empower ourselves with knowledge.

Vaginal cancer stages indicate the extent of the disease:

Stage 0: Precancerous cells are present but confined to the surface of the vagina.

Stage I: Cancer has formed and is confined to the vaginal wall.

Stage II: Cancer has spread beyond the vagina to the tissue around it but not to the pelvic wall.

Stage III: Cancer has spread to the pelvic wall and/or nearby lymph nodes.

Stage IV: Cancer has spread to distant body parts, such as the lungs or liver.

Facing vaginal cancer can be daunting. Let’s explore the hurdles patients face with resilience and empathy.

Individuals encounter various challenges along their journey, such as:

Managing the costs associated with cancer treatment, including medical bills, medication expenses, and transportation costs, can be overwhelming. Lost income due to treatment and recovery leave may add to the financial burden.

After completing treatment, survivors may face challenges related to rehabilitation. These include managing long-term side effects, regaining physical strength, and adjusting to life after cancer. Survivorship care plans and services can help individuals address ongoing healthcare needs.

According to the seasoned oncologist in Bangalore and Samrohana founder, Dr. Sandeep Nayak:

“It’s crucial to address patients’ psychological and emotional needs throughout the cancer journey. Counseling and support groups can provide valuable support and coping strategies for patients and their families.”

When it comes to treating vaginal cancer, patients have several options available. Let’s explore each option to help you make informed decisions about your care.

Here’s a breakdown of the treatment modalities commonly used:

Immunotherapy uses the body’s immune system to spot and attack cancer cells. Checkpoint inhibitors, a form of immunotherapy, exhibit remarkable potential in combating specific cancers. These include those associated with the vaginal, colorectal, and cervical regions. Checkpoint inhibitors may help where other treatments have failed to boost the body’s natural defenses.

Palliative care focuses on improving the quality of life for patients. It addresses symptoms such as pain, fatigue, and emotional distress. Additionally, it may involve dietary guidance to optimize nutrition and overall well-being. Palliative caregivers also provide crucial support by offering comfort and assistance to patients and their families.

Dr. Sandeep Nayak, a renowned oncologist in Bangalore, elaborates:

“The choice of treatment for vaginal cancer depends on various factors. These include the cancer stage, location, patient’s overall health, and personal preferences. A multidisciplinary team of healthcare providers work together to develop treatment plans tailored to each patient’s needs.”

Vaginal cancer after hysterectomy is relatively rare. However, being aware of the signs and treatment options available are vital steps in managing this disease effectively. Regular follow-ups with healthcare providers ensure any potential issues are addressed promptly.

Despite the challenges, individuals can find support and resources to navigate their journey with resilience and strength. Healthcare providers and support networks empower patients by addressing physical, emotional, and practical needs. This approach helps patients face challenges head-on and achieve the best possible outcomes.

Unveil FAQs about breast cancer after menopause. Let’s get your questions answered.

1. At what age is vaginal cancer most common?

Vaginal cancer is most commonly diagnosed in women aged 60 and older, but it can occur at any age.

2. Who is at high risk for vaginal cancer?

High-risk groups include:

• women with a history of HPV infection
• those who have had previous cervical or uterine cancer
• women who have undergone pelvic radiation therapy

3. Is a recurrence vaginal cancer after hysterectomy possible?

Yes, cancer can spread after a total hysterectomy if:

• microscopic cancer cells had already escaped the uterus before the surgery
• cancer develops afresh in the remaining vaginal tissue

The likelihood of vaginal cancer recurring after a hysterectomy depends on various factors. These include the cancer stage during diagnosis, treatment success, and individual health factors.