Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer

Mukai, Toshiki; Akiyoshi, Takashi; Ueno, Masashi; Fukunaga, Yosuke; Nagayama, Satoshi; Fujimoto, Yoshiya; Konishi, Tsuyoshi; Ikeda, Atsushi; Yamaguchi, Toshiharu

doi:10.1111/ases.12047

Cited by 31 publications

(23 citation statements)

References 11 publications

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“…The locally advanced and locally recurrent rectal cancers with invasion limited to the anterior pelvic organ are good candidates for laparoscopic pelvic exenteration as a free circumferential margin can be achieved easily [28] . The b-TME Collaborative has generated a consensus guideline suggesting certain contraindications for these resections [7] , which holds true for MIS also.…”

Section: Pelvic Exenterationmentioning

confidence: 99%

“…Patients who underwent multiple laparotomies and predicted to have severe small bowel adhesion are precluded from having MIS [29] . Initial experience in laparoscopic pelvic exenteration was reported in few case reports and video vignette [28,30] . Akiyoshi et al [31] demonstrated an laparoscopic pelvic exenteration for locally recurrent rectal cancer and suggested that laparoscopic pelvic exenteration was a technically challenging procedure that requires a long operative time with benefits of a very clear view of the operative field, allowing precise dissection, less blood loss, and a smaller abdominal wound.…”

Section: Pelvic Exenterationmentioning

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: Pelvic Exenterationmentioning

confidence: 99%

Section: Pelvic Exenterationmentioning

confidence: 99%

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

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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“…12 Cases of laparoscopic and robotic TPE for urologic or gynecologic malignancies have been reported, [7][8][9][10] and multiport laparoscopic TPE for advanced rectal cancer has been reported. 11 Many surgeons have attempted to reduce the number of ports in laparoscopic surgery. Reduced port surgery aims to reduce the size and number of ports for preserving the view afforded by the laparoscope, while making the surgery less invasive.…”

Section: Discussionmentioning

confidence: 99%

“…6 Cases of laparoscopic and robotic TPE for urologic or gynecologic malignancies have been reported, [7][8][9][10] and multiport laparoscopic TPE for advanced rectal cancer has been reported. 11 However, SILS plus 1 port (SILSþ1) TPE for advanced primary rectal cancer has not been examined. In this report, we describe the SILSþ1 TPE for advanced primary rectal cancer.…”

mentioning

confidence: 99%

Single-Incision Plus One Port Laparoscopic Total Pelvic Exenteration After Neoadjuvant Chemotherapy for Advanced Primary Rectal Cancer: A Case Report

Tokuoka

Ide

Yamato

et al. 2015

International Surgery

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Limited data on laparoscopic and robotic total pelvic exenteration (TPE) for gynecologic, urologic, and rectal malignancies have been published in the literature. Single-incision laparoscopic surgery (SILS) has been successfully introduced for colon cancer. Here, we describe our experience of TPE with SILS þ 1 port (SILSþ1) for advanced rectal cancer. A 64-year-old man was referred to our hospital with anemia. Computed tomography (CT) revealed a rectal tumor that was contiguous with the seminal vesicle and bladder. Rectoscopy revealed an ulcerated, bleeding, and stricturing lesion in the rectum, which was defined as an adenocarcinoma with a moderate degree of differentiation on histologic examination. The patient received neoadjuvant chemotherapy using capecitabine, oxaliplatin, and bevacizumab. After 3 courses of chemotherapy, a rectovesical fistula was suspected from examination of CT images. CT demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. Thus, we constructed a transverse loop colostomy. Two months after the last administration of chemotherapy, we performed SILSþ1 TPE. The procedure involved a 35-mm incision in the right side of the umbilicus for the insertion of a single multichannel port, and insertion of a 12-mm port into the right lower quadrant. Total operating time was 751 minutes, and estimated blood loss was 1100 mL (including urine). SILSþ1 TPE is a Corresponding author: Masayoshi Tokuoka, MD, 1-3-1, Ryuge, Yao-city, Osaka 581-0069, Japan. Key words: Single-incision laparoscopic total pelvic exenteration -Rectal cancer -Reduced port surgery S ingle-incision laparoscopic surgery (SILS) has been successfully introduced for colectomy. [1][2][3][4][5] Total pelvic exenteration (TPE) is the only curative procedure for T4 rectal cancer that directly invades the urinary or gynecologic tract. 6 Cases of laparoscopic and robotic TPE for urologic or gynecologic malignancies have been reported, [7][8][9][10] and multiport laparoscopic TPE for advanced rectal cancer has been reported.11 However, SILS plus 1 port (SILSþ1) TPE for advanced primary rectal cancer has not been examined. In this report, we describe the SILSþ1 TPE for advanced primary rectal cancer. Patient and MethodsA 64-year-old man was referred to our hospital with anemia. Physical examination and urine and blood tests revealed hemoglobin of 5.7 g/dL. Computed tomography (CT) revealed a rectal tumor (Fig. 1a) that was contiguous with the seminal vesicle and bladder (Fig. 1b). Rectoscopy revealed an ulcerated, bleeding, and stricturing lesion in the rectum with 9 cm from anal verge, which was defined as an adenocarcinoma with a moderate degree of differentiation on histologic examination (Fig. 2). The level of carcinoembryonic antigen (CEA) was 25 ng/mL. The patient received neoadjuvant chemotherapy using capecitabine, oxaliplatin, and bevacizumab without radiotherapy. After 3 courses of chemotherapy, the patient had fecaluria. A rectovesical fistula was suspected from examination of CT i...

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“…Multi‐visceral resection for T4 colorectal cancer has acceptable morbidity and mortality rates and a fair long‐term prognosis 4. Recent reports suggest that minimally invasive techniques for multi‐visceral resection should help achieve adequate short‐term outcomes and improvements in quality of life 5, 6, 7. Here, we describe our experience of complete en bloc resection by anal‐preserving laparoscopic anterior pelvic exenteration in a patient with locally advanced rectosigmoid cancer with direct invasion of the urinary bladder.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation

Ishizaki

Nakashima

Hamada

et al. 2015

Asian J Endoscop Surgery

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Laparoscopic multi‐visceral resection in patients with T4 colorectal cancer remains controversial. A 73‐year‐old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long‐term follow‐up are required to resolve oncological outcomes.

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Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer

Cited by 31 publications

References 11 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

Single-Incision Plus One Port Laparoscopic Total Pelvic Exenteration After Neoadjuvant Chemotherapy for Advanced Primary Rectal Cancer: A Case Report

Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation

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