First report: robotic pelvic exenteration for locally advanced rectal cancer

Shin, Jae Won; Kim, J.; Kwak, Jungwon; Hara, Masayasu; Cheon, Jeong Hyun; Kang, Seongwon; Kang, Seok Hyung; Stevenson, Andrew; Coughlin, Geoff; Kim, S. H.

doi:10.1111/codi.12446

Cited by 42 publications

(22 citation statements)

References 22 publications

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“…Video demonstrates our standardized technique of TPE, using the da Vinci Xi robotic platform, after neoadjuvant chemoradiation in a patient with locally advanced rectal cancer. The surgical duration and blood loss are in line with other reported series on robotic rectal cancer exenterative surgeries.…”

supporting

confidence: 88%

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Robotic total pelvic exenteration for locally advanced rectal cancer – a video vignette

et al. 2018

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supporting

confidence: 88%

“…Robotic TPE for rectal cancer was shown to be feasible technically in 2014 on a daVinci Si platform . Compared with laparoscopy, robotic surgery removes dependence on an assistant for vision and affords excellent dexterity, and the three‐dimensional (3D) platform provides an unparalleled advantage to work in a narrow male pelvis.…”

mentioning

confidence: 99%

Robotic total pelvic exenteration for locally advanced rectal cancer – a video vignette

et al. 2018

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“…One of the first reports of robotic pelvic exenteration for locally advanced rectal cancer come from Shin et al [44] . They described three cases including two extended resections with en bloc prostatectomy and intracorporeal vesicourethral anastomosis, and one total pelvic exenteration with intracorporeal ileal conduit.…”

Section: Ogura Et Almentioning

confidence: 99%

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.

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“…The preliminary data have shown minimal blood loss, short hospital stays, low morbidity rates, and non-comprising short-term oncological outcome. The first report of robotic PE in advanced rectal cancer patients was published by Shin et al[24] in 2014. The authors reported on 3 consecutive male patients with locally advanced rectal cancer involving prostate and seminal vesicles.…”

Section: Discussionmentioning

confidence: 99%

Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases

Chew

Yeh

Toh

et al. 2017

WJGO

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AIMTo critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit.METHODSThis retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome. Quantitative data were summarized as percentage or median and range, and statistically assessed by the χ2 test or Fisher’s exact test, as applicable.RESULTSAll 25 patients received comprehensive preoperative assessment via our dedicated multidisciplinary team approach. Long-course neoadjuvant chemoradiotherapy was provided, if indicated. The median age of the patients was 61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4 anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up period was 17.6 mo. The median operative time was 11.5 h. The median volume of blood loss was 3306 mL, and the median volume of red cell transfusion was 1475 mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d, respectively. There was no case of mortality related to surgery. There were a total of 20 surgical morbidities, which occurred in 12 patients. The majority of the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3 Clavien-Dindo complications, and both required procedural interventions. One patient experienced grade 4a Clavien-Dindo complication, requiring temporary renal dialysis without long-term disability. The R0 resection rate was 64%. There were 7 post-exenteration recurrences during the follow-up period. No statistically significant relationship was found among histological origin of tumour, microscopic resection margin status and postoperative recurrence (P = 0.67). Four patients died from sequelae of recurrent disease during follow-up.CONCLUSIONBy utilizing modern assessment and surgical techniques, our PE Unit can manage complex pelvic cancers with acceptable morbidities, zero-rate mortality and equivalent oncologic outcomes.

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First report: robotic pelvic exenteration for locally advanced rectal cancer

Cited by 42 publications

References 22 publications

Robotic total pelvic exenteration for locally advanced rectal cancer – a video vignette

Robotic total pelvic exenteration for locally advanced rectal cancer – a video vignette

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases

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