A colonoscopy at Tam Anh General Hospital, Ho Chi Minh City, revealed an infiltrative ulcerated lesion in Kim's rectum, measuring 15 mm and occupying about one-third of the rectal lumen's circumference. A biopsy confirmed moderately differentiated rectal adenocarcinoma, stage two, with no distant metastasis.

Doctor Do Minh Hung, Director of the Center for Endoscopy and Gastrointestinal Laparoscopic Surgery at Tam Anh General Hospital, Ho Chi Minh City, stated that Kim's cancer cells had deeply invaded the layers of the rectal wall. The optimal treatment involved robotic proctectomy to remove the tumor-containing segment, combined with lymphadenectomy. This approach aimed to completely eliminate cancer cells, reduce the risk of recurrence, and prevent tumor progression that could lead to bowel obstruction, bleeding, or perforation, potentially resulting in peritonitis.

According to Doctor Hung, Kim was elderly and frail, with multiple underlying health conditions, including heart failure, myocardial ischemia, chronic kidney failure, hypertension, and atrial fibrillation. She had a pacemaker implanted one year prior. Doctors were concerned that a prolonged major surgery could overtax her system, increasing the risk of myocardial infarction, intraoperative cardiac arrest, or extended postoperative respiratory failure.

To prepare for surgery, Kim underwent pleural fluid drainage to improve lung expansion and respiratory function. Doctors also checked her pacemaker's function, adjusted her anticoagulant medication, and discontinued it 5 days before surgery to minimize the risk of bleeding.

The robot performs tumor resection for Kim under the doctor's control. *Photo: Tam Anh General Hospital*

The surgeon, controlling the robotic system, opened the peritoneum, performed dissection, lymphadenectomy, and ligated the artery at its root. The robotic arms navigated deep into the narrow pelvis, dissecting the entire tumor and perirectal fat.

After resecting the rectum approximately 2 cm below the tumor, the surgeon made a small incision below the navel to extract the specimen. They then resected the colon approximately 20 cm above the tumor and reconnected the two ends of the bowel.

The human pelvis is typically narrow and deep, making traditional open or laparoscopic surgery challenging. However, the robot can rotate flexibly in confined spaces. Magnified 3D images help surgeons clearly visualize anatomical structures, preserve pelvic autonomic nerves, and minimize ureteral damage.

Doctor Hung operates the robot from the control console to remove a deep rectal tumor from Kim. *Photo: Tam Anh General Hospital*

Two days after surgery, Kim's health recovered significantly. She could sit up, engage in light activity, consume liquid food, and was discharged without postoperative complications. Pathological results showed cancer cells had invaded the muscle layer but had not metastasized to the lymph nodes. A total of 10 resected lymph nodes were all negative. Both resection margins were clear of cancer cells. The disease was classified as stage 2A, requiring no additional treatment.

Colorectal cancer is common in Vietnam, with a high number of new cases and fatalities. The disease is often detected at a late stage due to vague symptoms, typically when the tumor has invaded or metastasized to the liver, lungs, and other organs, making treatment difficult.

According to Doctor Hung, rectal cancer can be cured in over 90% of cases if detected early. He recommends that individuals aged 45 and older, or those with a family history of polyps or colorectal cancer, undergo regular health check-ups and screenings as advised by a doctor. Early detection and removal of precancerous polyps significantly reduce the risk of progression to invasive cancer.

Quyen Phan

*Patient's name has been changed