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Transperineal retropubic approach in total pelvic exenteration for advanced and recurrent colorectal and anal cancer involving the penile base: technique and outcomes

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Abstract

Background

Complete pathological resection of locally advanced and recurrent anorectal cancer is considered the most important determinant of survival outcome. Involvement of the retropubic space with cancer threatening or involving the penile base poses specific challenges due to the potential for margin involvement and blood loss from the dorsal venous plexus. In the present study we evaluate a new transperineal surgical approach to excision of anterior compartment organs involved or threatened by cancer which facilitates exposure and visualisation of the bulbar urethra and the deep vein of the penis caudal to the retropubic space and penile base.

Methods

A retrospective study was performed on male patients with tumour extension into the penile base treated at our institution using the transperineal surgical approach. Descriptive data for patient demographics, radiology, operative details, postoperative histology, complications and outcomes were collated.

Results

Ten male patients with tumour extension into the penile base were identified. Two patients had recurrent anal cancer, 6 had locally advanced primary rectal cancer and 2 had recurrent rectal cancer. All patients had exenterative surgery with excision of the penile base utilising the transperineal approach. All patients had R0 resection. No local recurrence developed after a median follow up period of 15 months.

Conclusions

The transperineal approach to the penile base and retropubic space allows for high rates of R0 resection margin status with direct visualisation of the dorsal venous plexus, thereby minimising blood loss. In our experience, this technique is the preferred approach to excision of cancers threatening and involving the penile base and also for most male patients requiring total pelvic exenteration.

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Acknowledgements

The authors would like to thank Steve Preston for his invaluable assistance in developing the schematic diagrams used in this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Complex Cancer Clinic, St. Mark’s Hospital, London, UK

    A. M. Mehta, A. Antoniou & J. T. Jenkins

  2. Department of Urology, Complex Cancer Clinic, St. Mark’s Hospital, London, UK

    G. Hellawell

  3. Department of Gastro-intestinal Radiology, Complex Cancer Clinic, St. Mark’s Hospital, London, UK

    D. Burling

  4. Department of Anaesthetics, Complex Cancer Clinic, St. Mark’s Hospital, London, UK

    S. Littler

Authors
  1. A. M. Mehta
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  2. G. Hellawell
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  3. D. Burling
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  4. S. Littler
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  5. A. Antoniou
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  6. J. T. Jenkins
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Corresponding author

Correspondence to J. T. Jenkins.

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The authors declare that they have no conflict of interest.

Ethical approval

As the current study was retrospective analysis of established clinical practice, formal consent was not required.

Informed consent

All patients provided informed consent prior to surgery.

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Mehta, A.M., Hellawell, G., Burling, D. et al. Transperineal retropubic approach in total pelvic exenteration for advanced and recurrent colorectal and anal cancer involving the penile base: technique and outcomes. Tech Coloproctol 22, 663–671 (2018). https://doi.org/10.1007/s10151-018-1852-8

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  • DOI: https://doi.org/10.1007/s10151-018-1852-8

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