The clinical impact of robot‐assisted laparoscopic rectal cancer surgery associated with robot‐assisted radical prostatectomy

Abstract

Introduction: Robot-assisted laparoscopic surgery has been performed in various fields, especially in the pelvic cavity. However, little is known about the utility of robot-assisted laparoscopic rectal cancer surgery associated with robot-assisted radical prostatectomy (RARP). We herein report the clinical impact of robot-assisted laparoscopic rectal cancer surgery associated with RARP.Methods: We experienced five cases of robot-assisted laparoscopic rectal cancer surgery associated with RARP. One involved robot-assisted laparoscopic abdominoperineal resection with en bloc prostatectomy for T4b rectal cancer, and one involved robot-assisted laparoscopic intersphincteric resection combined with RARP for synchronous rectal and prostate cancer. The remaining three involved robot-assisted laparoscopic low anterior resection (RaLAR) after RARP. For robot-assisted laparoscopic rectal cancer surgery, the da Vinci Xi surgical system was used. Results: We could perform planned robotic rectal cancer surgery in all cases.The median operation time was 529 min (373-793 min), and the median blood loss was 307 ml (32-1191 ml). No patients required any transfusion in the intra-operative or immediate peri-operative period. The circumferential resection margin was negative in all cases. There were no complications of grade ≥III according to the Clavien-Dindo classification and no conversions to conventional laparoscopic or open surgery. Conclusion:Robot-assisted laparoscopic surgery associated with RARP is feasible in patients with rectal cancer. The long-term surgical outcomes remain to be further evaluated.

Robot‐assisted laparoscopic abdominoperineal resection with en bloc prostatectomy using the Retzius‐sparing robot‐assisted radical prostatectomy technique

“…7 We recently performed robotic APR with en bloc prostatectomy using a standard retropubic approach for rectal cancer invading the prostate. 4 Heah and Wong reported three cases of robot-assisted rectal cancer surgery with en bloc prostatectomy, and, as in our previous case, concluded that this procedure could be performed safely with acceptable surgical outcomes. 8 These results indicate that robot-assisted laparoscopic resection may be an acceptable treatment option for rectal cancer invading the prostate.…”

“…Furthermore, this approach is also expected to reduce adhesions around the pubis. Actually, we had great difficulty in dissection due to the presence of strong adhesions around the pubis when we have performed robotic low anterior resection after RARP 4 . So, we believe that it is very important to prevent pelvic adhesions because the number of cases of reoperation after RARP is expected to increase with the aging of society.…”

“…Robot‐assisted radical prostatectomy (RARP) is a standard therapeutic technique for localized prostate cancer 3 . We recently performed robot‐assisted laparoscopic abdominoperineal resection (APR) with en bloc prostatectomy using the standard retropubic approach for rectal cancer invading the prostate 4 . However, this approach makes it very difficult to perform lateral pelvic lymph node dissection (LPLND).…”

“…3 We recently performed robot-assisted laparoscopic abdominoperineal resection (APR) with en bloc prostatectomy using the standard retropubic approach for rectal cancer invading the prostate. 4 However, this approach makes it very difficult to perform lateral pelvic lymph node dissection (LPLND). To improve this shortcoming, we developed a new approach applying the technique of Retzius-sparing RARP (RS-RARP).…”

Current status of robot-assisted total pelvic exenteration focusing on the field of urology: a clinical practice review

“…Locally advanced or recurrent cervical cancer was dominant for indication for TPE in non-rectal pelvic malignancy, although all gynecological neoplasms (cervical, endometrial, vulvar, or ovarian carcinoma) and lower urinary tract neoplasms (bladder or prostate cancer) are also candidates for TPE as reported in previous literatures ( 15 , 16 ). Moreover, TPE is indicated in patients with both urological and colorectal cancer occurring at the same time ( 8 , 17 - 19 ). Indication for TPE depends on various factors, including previous treatments and presence of unresectable metastasis and invasion of the pelvic wall, sciatic nerve, or sacral nerve plexus.…”