Avoid common mistakes on your manuscript.
Squamous cell carcinoma of the anal canal is first treated with the Nigro protocol, a curative intended course of chemoradiation, first described in 1974 [1]. This treatment has a high success rate; however, up to 33% of patients have recurrent or persistent disease requiring operative treatment [2, 3]. The operation for these patients is an abdominoperineal resection (APR), commonly referred to as a salvage APR [2]. The morbidity and complication rates of this surgery have been described, with a wound complication rate as high as 80% [2, 3]. Despite this, disease-free survival rates have been described as high as 77% [3]. APR has been well described in the minimally invasive fashion, both robotically and laparoscopically [4].
We present a patient with persistent disease after completion of the Nigro protocol, with loco-regional advancement and invasion into the vagina. This patient received a robotic APR with en bloc resection of the posterior vagina and total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO), with a flap reconstruction of the vagina and perineum. This was a multidisciplinary surgical resection from various subspecialties, including colorectal surgery, gynecological oncology, and plastic and reconstructive surgery. Appropriate consent was obtained from the patient. While there are various descriptions of minimally invasive en bloc pelvic resections [5], there are few descriptions of a robotic resection of these specific anatomic structures.
Data availability
Data sharing is not applicable to this article, as no datasets were generated or analyzed during the current study.
References
Nigro ND, Vaitkevicius VK, Considine B (1974) Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 17(3):354–356. https://doi.org/10.1007/BF02586980
Papaconstantinou HT, Bullard KM, Rothenberger DA, Madoff RD (2006) Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity. Colorect Dis 8(2):124–129. https://doi.org/10.1111/j.1463-1318.2005.00911.x
Osborne MC (2014) Anal squamous cell carcinoma: an evolution in disease and management. World J Gastroenterol 20(36):13052. https://doi.org/10.3748/wjg.v20.i36.13052
Feng Q, Tang W, Zhang Z et al (2022) Robotic versus laparoscopic abdominoperineal resections for low rectal cancer: a single-center randomized controlled trial. J Surg Oncol 126(8):1481–1493. https://doi.org/10.1002/jso.27076
Yang SY, Kim NK (2020) Robotic partial excision of levator-ani muscle for locally advanced low rectal cancer invading ipsilateral pelvic floor. Ann Coloproctol 36(6):415–416. https://doi.org/10.3393/ac.2020.06.29
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Consent to publish
Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 582559 kb)
Rights and permissions
About this article
Cite this article
Meece, M.S., Horner, L.P., Danker, S.J. et al. Robotic APR with en bloc TAH/BSO and posterior vaginectomy. Tech Coloproctol 27, 1381 (2023). https://doi.org/10.1007/s10151-023-02860-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-023-02860-9