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Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion

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Abstract

Background

Transanal (Ta) pelvic exenteration is a promising, minimally invasive method for treating locally advanced colorectal cancer. However, since it is technically difficult to perform, Ta pelvic exenteration is rarely reported in locally advanced T4 rectal cancer cases. The aim of this study was to evaluate the feasibility of transabdominal laparoscopy-assisted Ta pelvic exenteration.

Methods

Six patients (4 males and 2 females) had laparoscopy-assisted Ta total or posterior pelvic exenteration for locally advanced or recurrent colorectal cancer cases at the Nagasaki University Hospital between September 2018 and August 2019. Clinical and pathological outcomes were measured and analyzed.

Results

The median operation time and intraoperative blood loss were 481 (range 456–709) minutes and 352.5 (range 257–1660) ml, respectively. R0 resection was achieved in all cases, and no patient required open surgery. Two patients had grade 3 complications (Clavien-Dindo) or higher. There was no mortality, and no reoperation was required.

Conclusions

The results suggest that laparoscopic-assisted Ta pelvic exenteration is an acceptable procedure, may help overcome the current technical difficulties, and may improve outcomes in patients with locally advanced rectal cancer.

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References

  1. Akiyoshi T, Nagasaki T, Ueno M (2015) Laparoscopic total pelvic exenteration for locally recurrent rectal cancer. Ann Surg Oncol 22:3896

    Article  Google Scholar 

  2. Uehara K, Nakamura H, Yoshino Y, Arimoto A, Kato T, Yokoyama Y, Ebata T, Nagino M (2016) Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery. Surg Endosc 30:132–138

    Article  Google Scholar 

  3. Melich G, Hong YK, Kim J, Hur H, Baik SH, Kim NK, Sender Liberman A, Min BS (2015) Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg Endosc 29:558–568

    Article  Google Scholar 

  4. Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258

    Article  CAS  Google Scholar 

  5. Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56:408–415

    Article  Google Scholar 

  6. Dumont F, Goéré D, Honoré C, Elias D (2012) Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum 55:996–1001

    Article  Google Scholar 

  7. Emhoff IA, Lee GC, Sylla P (2014) Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES). Dig Endosc 26:29–42

    Article  Google Scholar 

  8. Sohn DK, Park SC, Kim MJ, Chang HJ, Han KS, Oh JH (2019) Feasibility of transanal total mesorectal excision in cases with challenging patient and tumor characteristics. Ann Surg Treat Res 96:123–130

    Article  Google Scholar 

  9. Uematsu D, Akiyama G, Sugihara T, Magishi A, Yamaguchi T, Sano T (2017) Transanal total pelvic exenteration: pushing the limits of transanal total mesorectal excision with transanal pelvic exenteration. Dis Colon Rectum 60:647–648

    Article  Google Scholar 

  10. Uematsu D, Akiyama G, Sugihara T, Magishi A, Ono K, Yamaguchi T, Sano T (2019) Transperineal total pelvic exenteration in the prone jackknife position. Dis Colon Rectum 62:1135

    Article  Google Scholar 

  11. de’Angelis N, Landi F, Vitali G.C, Memeo R, Martínez-Pérez A, Solis A, Assalino M, Vallribera F, Mercoli H.A, Marescaux J, Mutter D, Ris F, Espin E, Brunetti F (2017) Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. Surg Endosc 31:3106–3121

  12. de Lacy FB, van Laarhoven JJEM, Pena R, Arroyave MC, Bravo R, Cuatrecasas M, Lacy AM (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32:2442–2447

    Article  Google Scholar 

  13. Zhang X, Gao Y, Dai XL, Zhang HT, Shang ZJ, Cai XY, Shen T, Cheng XS, Yu K, Li YF (2019) Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis. Surg Endosc 33:972–985

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  15. Brunschwig A (1949) Complete excision of pelvic viscera in the male for advanced carcinoma of the sigmoid invading the urinary bladder. Ann Surg 129:499–504

    Article  CAS  Google Scholar 

  16. López-Basave HN, Morales-Vásquez F, Herrera-Gómez Á, Rosciano AP, Meneses-García A, Ruiz-Molina JM (2012) Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution. Cancer Manag Res 4:351–356

    Article  Google Scholar 

  17. Platt E, Dovell G, Smolarek S (2018) Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer. Tech Coloproctol 22:835–845. https://doi.org/10.1007/s10151-018-1883-1

    Article  CAS  PubMed  Google Scholar 

  18. Yang K, Cai L, Yao L, Zhang Z, Zhang C, Wang X, Tang J, Li X, He Z, Zhou L (2015) Laparoscopic total pelvic exenteration for pelvic malignancies: the technique and short-time outcome of 11 cases. World J Surg Oncol 13:301

    Article  Google Scholar 

  19. Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M (2016) Safety of laparoscopic pelvic exenteration with urinary diversion for colorectal malignancies. World J Surg 40:1236–1243

    Article  Google Scholar 

  20. Ichihara M, Uemura M, Ikeda M, Miyake M, Kato T, Hamakawa T, Maeda S, Hama N, Nishikawa K, Miyamoto A, Miyazaki M, Hirao M, Sekimoto M (2019) Safety and feasibility of laparoscopic pelvic exenteration for locally advanced or recurrent colorectal cancer. Surg Laparosc Endosc Percutan Tech 29:389–392

    PubMed  Google Scholar 

  21. Mehta AM, Hellawell G, Burling D et al (2018) 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. https://doi.org/10.1007/s10151-018-1852-8

    Article  CAS  PubMed  Google Scholar 

  22. S K.M (2017) Total Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer: Urological Outcomes and Adverse Events. Eur Urol Focus 6–11

  23. Denost Q, Kontovounisios C, Rasheed S, Chevalier R (2017) Individualizing surgical treatment based on tumour response following neoadjuvant therapy in T4 primary rectal cancer. Eur J Surg Oncol 43:92–99

    Article  CAS  Google Scholar 

  24. Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H (2016) Wang Z (2016) Transanal total mesorectal excision (taTME) for rectal cancer : a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 4(16):380

    Article  Google Scholar 

  25. Wasmuth H.H, Færden A.E, Myklebust T, Pfeffer F, Norderval S, Riis R, Olsen O.C, Lambrecht J.R, Kørner H, Larsen S.G, Forsmo H.M, Bækkelund O, Lavik S, Knapp J.C, Sjo O, Rashid G (2019) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg:121–130.

  26. Yasukawa D, Hori T, Kadokawa Y, Kato S, Aisu Y, Hasegawa S (2019) Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer. Surg Endosc 33:437–447

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    T. Nonaka, T. Tominaga, T. Sawai & Takeshi Nagayasu

  2. Department of Pathology, Nagasaki University Graduate School of Biological Sciences, Nagasaki, Japan

    Y. Akazawa

  3. Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Y. Akazawa

Authors
  1. T. Nonaka
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  2. T. Tominaga
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  3. Y. Akazawa
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  4. T. Sawai
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  5. Takeshi Nagayasu
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Correspondence to T. Nonaka.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the Trust and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Nonaka, T., Tominaga, T., Akazawa, Y. et al. Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion. Tech Coloproctol 25, 69–74 (2021). https://doi.org/10.1007/s10151-020-02324-4

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  • DOI: https://doi.org/10.1007/s10151-020-02324-4

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