{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:51:20Z","timestamp":1791352280795,"version":"4.3.1"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Robot\u2010assisted pelvic exenteration (RPE) has been introduced as a minimally invasive option for selected patients; however, its clinical implementation, patient selection, and perioperative outcomes for primary rectal cancer remain unclear. This study describes the use and outcomes of RPE in a multicenter Japanese cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational secondary analysis included patients who underwent pelvic exenteration (PE) for primary rectal cancer at 26 Japanese institutions between January 2012 and October 2022. Patient characteristics, surgical indications, temporal trends in operative approach, and perioperative outcomes were summarized descriptively. Propensity score\u2010matched analyses were performed as supplementary exploratory analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 135 patients, 43 (32%) underwent RPE, 57 (42%) underwent laparoscopic PE, and 35 (26%) underwent open PE. In the RPE cohort, median operative time was 690\u2009min, median blood loss was 360\u2009mL, and 13 patients (30%) received intraoperative transfusion. One patient (2%) required conversion to open surgery, and RM0 resection was achieved in 42 (98%). Clavien\u2010Dindo Grade II or higher and Grade III or higher complications within 30\u2009days occurred in 16 (37%) and seven (16%) patients, respectively. No patient underwent reoperation during hospitalization or died within 30\u2009days. Grade III or higher morbidity between 31 and 90\u2009days occurred in five patients (12%). Median hospital stay was 23\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RPE was performed with acceptable perioperative outcomes in selected patients with primary rectal cancer. It may serve as a complementary approach at institutions with sufficient experience in PE, whereas open surgery remains essential for extensive or technically demanding disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70296","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:38:36Z","timestamp":1791351516000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Implementation and Perioperative Outcomes of\u00a0Robot\u2010Assisted Pelvic Exenteration for Primary Rectal Cancer: A Multicenter Japanese Experience"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6378-2049","authenticated-orcid":false,"given":"Shoma","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-8992","authenticated-orcid":false,"given":"Hiroyasu","family":"Kagawa","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Yatabe","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Kinugasa","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"2","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/SLA.0000000000002528","article-title":"Surgical and Survival Outcomes Following Pelvic Exenteration for Locally Advanced Primary Rectal Cancer: Results From an International Collaboration","volume":"269","author":"PelvEx Collaborative","year":"2019","journal-title":"Annals of Surgery"},{"issue":"6","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.ejso.2016.02.016","article-title":"Outcomes of Pelvic Exenteration for Locally Advanced Primary Rectal Cancer: Overall Survival and Quality of Life","volume":"42","author":"Quyn A. 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W.","year":"2015","journal-title":"British Journal of Surgery"},{"issue":"5","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrab074","article-title":"Minimally Invasive Versus Open Pelvic Exenterations for Rectal Cancer: A Comparative Analysis of Perioperative and 3\u2010Year Oncological Outcomes","volume":"5","author":"Kazi M.","year":"2021","journal-title":"BJS Open"},{"issue":"11","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1007\/s10151-018-1883-1","article-title":"Systematic Review of Outcomes Following Pelvic Exenteration for the Treatment of Primary and Recurrent Locally Advanced Rectal Cancer","volume":"22","author":"Platt E.","year":"2018","journal-title":"Techniques in Coloproctology"},{"issue":"5","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/bjs5.75","article-title":"Cohort Study of Long\u2010Term Survival and Quality of Life Following Pelvic Exenteration: Survival and Quality of Life After Pelvic Exenteration","volume":"2","author":"Steffens D.","year":"2018","journal-title":"BJS Open"},{"issue":"14","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1056\/NEJMoa1414882","article-title":"A Randomized Trial of Laparoscopic Versus Open Surgery for Rectal Cancer","volume":"372","author":"Bonjer H. 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L.","year":"2015","journal-title":"Journal of the American Medical Association"},{"issue":"16","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1001\/jama.2017.7219","article-title":"Effect of Robotic\u2010Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial","volume":"318","author":"Jayne D.","year":"2017","journal-title":"Journal of the American Medical Association"},{"issue":"1","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/SLA.0000000000005788","article-title":"Comparison of Laparoscopic Versus Robot\u2010Assisted Surgery for Rectal Cancers: The COLRAR Randomized Controlled Trial","volume":"278","author":"Park J. 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