Laparoscopic Pelvic Exenteration for Locally Advanced Rectal Cancer, Technique and Short-Term Outcomes

Pokharkar, Ashish; Kammar, Praveen; D’souza, Ashwin; Bhamre, Rahul; Sugoor, Pavan; Saklani, Avanish

doi:10.1089/lap.2018.0147

Cited by 17 publications

(12 citation statements)

References 21 publications

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“…In case of bleeding, we would increase abdominal gas pressure, pack with tape gauze, and suture during perineal part of surgery. In our study, blood loss was 1000 mL (range 300-2000 mL), mean duration of surgery was 9.13 h (range 7-13 h), and mean postoperative stay was 14.6 days (range 9-25 days) [38] . When compared to other studies, we have demonstrated good perioperative outcomes [ Table 1].…”

Section: Ogura Et Almentioning

confidence: 55%

“…We standardized our technique of laparoscopic pelvic exenteration [37,38] . We use standard five-port technique followed by medialto-lateral retroperitoneal dissection, inferior mesenteric artery division, dissection of retrorectal space up to origin of levator ani, pararectal space dissection after medializing ureters, dissection of paravesical space to the level of the endopelvic fascia, dissection of Retzius space, division of dorsal vein complex, urethral transection, division of ureters, sigmoid transection, perineal dissection, and Bricker's ileal conduit through small infraumbilical incision.…”

Section: Ogura Et Almentioning

confidence: 99%

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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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Section: Ogura Et Almentioning

confidence: 55%

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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“…9 The dorsal venous complex is divided at the last stage of the pelvic dissection and in case there is any inadvertent bleeding, the intra-abdominal pneumo-peritoneum pressure is increased, the area packed with tape gauze and the bleeding vessel sutured during the perineal portion of the surgery. 9,15 The mean operative time was significantly longer in the MIS group when compared to the OPE group, but this was still lesser time when compared to other reports (Table 4). 5,21 The longer duration of MIS could be due to multiple factors such as the learning curve as our reports included all initial cases of MIS, the fact that surgical trainees as residents and fellows would perform the initial part of surgery and because of the extra time taken for intracorporeal urinary conduit, more number of LPLNDs and plastic reconstruction.…”

Section: Discussionmentioning

confidence: 64%

“… 10 We regularly perform exenterative surgeries, extended resections and multivisceral resections for CRC cases. 11 – 13 Our initial experience with regard to laparoscopic exenteration 14 – 15 and the techniques of robotic exenteration 16 – 18 were published previously. 9 There were only a few studies, which had compared MIS with open PE (OPE).…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer

Kumar

Sasi

Shinde

et al. 2020

JSLS

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Background: Minimally invasive surgery (MIS) for pelvic exenteration is not a well-established technique. The aim was to assess the safety and feasibility of MIS for pelvic exenteration in locally advanced primary colorectal cancer and to compare the perioperative outcomes with open surgery. Methods: This is a retrospective analysis of patients, who had undergone pelvic exenteration for primary colorectal adenocarcinoma from May 2013 to July 2018. The shortterm outcomes like perioperative details and histopathological characteristics were compared between the two groups. Results: MIS was performed in 23 patients and open pelvic exenteration was carried out in 72 patients. The mean operative time was significantly more in the MIS group (640 vs. 432 min, p ϭ 0.00). The intraoperative blood loss (900 vs. 1550 ml, p ϭ 0.00) and the requirement for blood transfusion (170 vs. 250 ml, p ϭ 0.03) was significantly less in the MIS group. The overall morbidity (60% vs. 49%, p ϭ 0.306) was comparable between the two groups. The median length of hospital stay in the MIS group was 11 d, compared to 12 d in the open surgery group, (p ϭ 0.634). The rate of R0 resection (87% vs. 89%, p ϭ 0.668) was comparable between the two groups. Conclusion: MIS is feasible and safe for total pelvic exenteration and posterior exenteration in carefully selected locally advanced primary colorectal cancer, when performed by an experienced surgical team in high volume centers. An R0 resection with adequate margin can be achieved with good perioperative outcomes in MIS. Long-term oncological outcomes would require further follow up to confirm.

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“…8 Also, laparoscopic resection for beyond and extended total mesorectal excision is performed with good short-term outcomes. 9,10 Owing to complete lockdown, when there is a shortage of blood supply, laparoscopic surgery will be advantageous as it gives minimal blood loss, decreased ward stay, and minimum intervention by staff for dressing and monitoring.…”

Section: Discussionmentioning

confidence: 99%

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma

Pawar

Pokharkar

Gori

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction:The recent COVID-19 pandemic outbreak has made surgeons change and take on newer strategies and safe exercises. All elective cases have been put off, but oncology cases need to be done to prevent progression of the disease. There is concern about minimally invasive surgery due to aerosol formation. Here we discuss how we have dealt with this in our colorectal surgery department taking into account current evidence about the danger of viral transmission during laparoscopic surgery. Discussion: We report a case of 28 years old female patient with carcinoma rectum. The patient had near total intestinal obstruction. She was operated on utilizing laparoscopic anterior resection. The air seal (CONMED, Utica, NY) and high-efficiency particulate air (HEPA) filter was utilized for safe gas evacuation. There is no evidence against laparoscopic surgery, which suggest viral transmission. One should take utmost precautions using N95 masks and personal protective equipment (PPE). Air filtration products like aerosol, HEPA filters will be of great aid in safe evacuation of gases. Conclusion: At present, there is no solid evidence to suggest viral transmission through surgical smoke. We believe due to effective smoke containment, less blood loss, and less postoperative stay, laparoscopy will be a non-inferior option than open surgical procedure. We advise taking all precautions for operating room staff to lessen the danger of transmission.

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Laparoscopic Pelvic Exenteration for Locally Advanced Rectal Cancer, Technique and Short-Term Outcomes

Cited by 17 publications

References 21 publications

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

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

Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma

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