Robotic pelvic exenteration and extended pelvic resections for locally advanced or synchronous rectal and urological malignancy.

2021

Williams, Michael

Perera, Marlon

Nouhaud, François Xavier

Coughlin, Geoffrey

Colorectal cancer

Minimally invasive surgical procedures

Pelvic exenteration

Prostate cancer

Surgery

Journal Article

0000-0002-3389-3875

0000-0002-1138-6389

0000-0003-3764-9949

0000-0003-0443-7966

10.4111/icu.20200176

To describe the surgical technique and examine the feasibility and outcomes following robotic pelvic exenteration and extended pelvic resection for rectal and/or urological malignancy. We present a case series of seven patients with locally advanced or synchronous urological and/or rectal malignancy who underwent robotic total or posterior pelvic exenteration between 2012-2016. In total, we included seven patients undergoing pelvic exenteration or extended pelvic resection. The mean operative time was 485±157 minutes and median length of stay was 9 days (6-34 days). There was only one Clavien-Dindo complication grade 3 which was a vesicourethral anastomotic leak requiring rigid cystoscopy and bilateral ureteric catheter insertion. Eighty-five percent of patients had clear colorectal margins with a median margin of 3.5 mm (0.7-8.0 mm) while all urological margins were clear. Six out of seven patients had complete (grade 3) total mesorectal excision. Three patients experienced recurrence at a median of 22 months (21-24 months) post-operatively. Of the three recurrences, one was systemic only whilst two were both local and systemic. One patient died from complications of dual rectal and prostate cancer 31 months after the surgery. We report a large series examining robotic pelvic exenteration or extended pelvic resection and describe the surgical technique involved. The robotic approach to pelvic exenteration is highly feasible and demonstrates acceptable peri-operative and oncological outcomes. It has the potential to benefit patients undergoing this highly complex and morbid procedure.

link

Investigative and clinical urology 2021; 62(1): 111-120

Investigative and Clinical Urology