The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review

Chang, Tou Pin; Chok, Aik Yong; Tan, Dominic Ti Ming; Rogers, Ailín C.; Tekkis, Paris; Kontovounisios, Christos

doi:10.3390/jcm10071518

Cited by 19 publications

(15 citation statements)

References 28 publications

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“…Furthermore, the rectum and colon have different anatomical locations, with the pelvis being an especially difficult area to work in laparoscopically owing to its narrow cavity and depth. For rectal pathologies, robotic surgery offers greater depth perception, 30 superior rotation, and acute angulation, creating a bigger work space compared to laparoscopic surgery 31 . These benefits are not as well defined in robotic colon surgery.…”

Section: Discussionmentioning

confidence: 99%

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Wang

Johnson

Casey

et al. 2022

ANZ Journal of Surgery

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Background: Colon cancer resection can be technically difficult in the obese (OB) population. Robotic surgery is a promising technique but its benefits remain uncertain in OB patients. The aim of this study is to compare OB versus non-obese (NOB) patients undergoing robotic colon surgery, as well as OB patients undergoing robotic versus open or laparoscopic colonic surgery. Methods: A systematic review and meta-analysis was performed. Primary outcome measures included length of stay (LOS), surgical site infection (SSI) rate, complications, anastomotic leak and oncological outcomes. Results: A total of eight studies were included, with five comparing OB and NOB patients undergoing robotic colon surgery included in meta-analysis. A total of 263 OB patients and 400 NOB patients formed the sample for meta-analysis. There was no significant difference between the two groups in operative time, conversion to open, LOS, lymph node yield, anastomotic leak and postoperative ileus. There was a trend towards a significant increase in overall complications and SSI in the OB group (32.3% OB versus 26.8% NOB for complications, 14.2% OB versus 9.9% NOB for SSI). The three included studies comparing surgical techniques were too heterogeneous to undergo meta-analysis. Conclusion: Robotic colon surgery is safe in obese patients, but high-quality prospective evidence is lacking. Future studies should report on oncological safety and the costeffectiveness of adopting the robotic technique in these challenging patients.

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Section: Discussionmentioning

confidence: 99%

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Wang

Johnson

Casey

et al. 2022

ANZ Journal of Surgery

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“…Laparoscopic pelvic exenteration has been associated with reduced blood loss, faster recovery and an acceptable length of stay; on the contrary, in well-selected patients, the learning curve is steep [ 92 ]. Robotic-assisted surgery facilitates a more ergonomic and visually enhanced platform [ 93 ].…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

“…This study demonstrated the safety and feasibility of MIS exenteration in patients with favourable anatomy and tumour characteristics [ 1 ]. Moving forward, novel robotic technology such as fluorescence-guided surgery, 3-dimensional modelling and stereotactic navigation will significantly improve surgical dissection and resection margins [ 93 ]. Fluorescence-guided surgery was established in several different specialities.…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Collaborative¹

2022

Cancers

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Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.

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“…Patients who underwent pelvic exenteration have a low 5-year survival rate according to early literature. Along with the confirmation of surgical indications, mastery of surgical techniques, and improved diagnosis and treatment for perioperative complications, the postoperative 5-year survival rate has increased from 20% in an earlier period to 64% [ 5 ]. A systematic review indicated that a positive surgical margin is an important prognostic indicator in pelvic exenteration.…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic exenteration is a complicated procedure with intraoperative and postoperative comorbidity-related mortality rate of 0–12%. Previous studies have shown that the survival rates of patients with postoperative complications is significantly reduced [ 5 ]. Resection of pelvic tissues that receive radiotherapy may lead to various fistulas, poor wound prognosis, and secondary problems caused by ureteral or intestinal obstruction.…”

Section: Introductionmentioning

confidence: 99%

Application of depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration

Zhang

Yang

2022

BMC Surg

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Background Pelvic exenteration is a radical surgery performed in selected patients with locally advanced or recurrent pelvic malignancy. It involves radical en bloc resection of the adjacent anatomical structures affected by the tumor. The authors sought to evaluate the clinical application of a depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration. Methods A total of 31 patients who underwent pelvic floor reconstruction with a gracilis adipofascial flap after pelvic exenterationat Peking University Third Hospital from 2014 to 2022 were enrolled in the study. The postoperative follow-up durations varied from 4 to 12 months. Results The survival rate of the flap was 96.77% with partial flap necrosis in one case. The total incidence of postoperative complications associated with the flap was 25.81%, with an incidence of 6.45% in the donor site and 19.35% in the recipient site. All complications were early complications, including postoperative infection and flap necrosis. All patients recovered after treatments, including anti-infectives, dressing change, debridement, and local flap repair. Long-term follow-up showed good outcomes without flap-related complications. Conclusions A depithelized gracilis adipofascial flap can be applied for pelvic floor reconstruction after pelvic exenteration. The flap is an ideal and reliable choice for pelvic floor reconstruction with few complications, an elevated survival rate, sufficient volume, and mild effects on the function of the donor site.

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The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review

Cited by 19 publications

References 28 publications

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Application of depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration

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