Skip to main content

Advertisement

SpringerLink
Log in

Feasibility of transanal minimally invasive surgery for total pelvic exenteration for advanced primary and recurrent pelvic malignancies

  • Multimedia Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to clarify the efficacy and safety of transanal minimally invasive surgery (TAMIS) for total pelvic exenteration (TPE) in advanced primary and recurrent pelvic malignancies.

Methods

Using a prospectively collected database, we retrospectively analyzed the clinical, surgical, and pathological outcomes of TAMIS for TPE. Surgery was performed between September 2019 and April 2023. The median follow-up period was 22 months (2–45 months).

Results

Fifteen consecutive patients were included in this analysis M:F = 14:1 and median (range) age was 63 (36–74). Their diagnoses were as follows: primary rectal cancer (n = 5; 33%), recurrent rectal cancer (n = 4; 27%), primary anorectal cancer (n = 5; 33%), and gastrointestinal stromal tumor (n = 1; 7%). Bladder-sparing TPE was selected for two patients (13%). In nine of 15 patients (60%) the anal sphincter could be successfully preserved, five patients (33%) required combined resection of the internal iliac vessels, and two (13%) required rectus muscle flap reconstruction. The median operative time was 723 min (561–1082), and the median intraoperative blood loss was 195 ml (30–1520). The Clavien–Dindo classifications of the postoperative complications were as follows: grade 0–2 (n = 11; 73%); 3a (n = 3; 20%); 3b (n = 1; 7%); and ≥ 4 (n = 0; 0%). No cases of conversion to laparotomy or mortality were observed. The pathological results demonstrated that R0 was achieved in 14 patients (93%).

Conclusions

The short-term outcomes of this initial experience proved that this novel approach is feasible for TPE, with low blood loss, acceptable postoperative complications, and a satisfactory R0 resection rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated and/or analyzed during the current study available from the corresponding author on reasonable request.

References

  1. Carvalho F, Qiu S, Panagi V et al (2023) Total pelvic exenteration surgery - considerations for healthcare professionals. Eur J Surg Oncol 49:225–236

    Article  PubMed  Google Scholar 

  2. Sylla P, Rattner DW, Delgado S et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  3. Hasegawa S, Kajitani R, Matsumoto Y et al (2020) Combined laparoscopic and transperineal endoscopic total pelvic exenteration for local recurrence of rectal cancer. Tech Coloproctol 24:599–601

    Article  CAS  PubMed  Google Scholar 

  4. Hayashi K, Kotake M, Kakiuchi D et al (2016) Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer. Surg Case Rep 2:74

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nonaka T, Tominaga T, Akazawa Y, Sawai T, Nagayasu T (2021) Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion. Tech Coloproctol 25:69–74

    Article  CAS  PubMed  Google Scholar 

  6. Heah NH, Wong KY (2020) Feasibility of robotic assisted bladder sparing pelvic exenteration for locally advanced rectal cancer: a single institution case series. World J Gastrointest Surg 12(4):190–196

    Article  PubMed  PubMed Central  Google Scholar 

  7. Saito N, Suzuki T, Sugito M et al (2007) Bladder-sparing extended resection of locally advanced rectal cancer involving the prostate and seminal vesicles. Surg Today 37:845–852

    Article  PubMed  Google Scholar 

  8. Beppu N, Jihyung S, Takenaka Y et al (2023) Transanal minimally invasive surgical approach to total pelvic exenteration. Dis Colon Rectum 66:e951–e957

  9. Japanese Society for Cancer of the Colon and Rectum (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma: 3rd English edition. J Anus Rectum Colon 3:175–195

    Article  PubMed Central  Google Scholar 

  10. Winters BR, Mann GN, Louie O, Wright JL (2015) Robotic total pelvic exenteration with laparoscopic rectus flap: Initial experience. Case Rep Surg 2015:835425

  11. Yang K, Cai L, Yao L et al (2015) Laparoscopic total pelvic exenteration for pelvic malignancies: the technique and short-time outcome of 11 cases. World J Surg Oncol 15(13):301

    Article  Google Scholar 

  12. Uehara K, Nakamura H, Yoshino Y et al (2016) Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery. Surg Endosc 30:132–138

    Article  PubMed  Google Scholar 

  13. Martinez A, Filleron T, Vitse L et al (2011) Laparoscopic pelvic exenteration for gynaecological malignancy: is there any advantage? Gynecol Oncol 120:374–379

    Article  CAS  PubMed  Google Scholar 

  14. PelvEx Collaborative (2018) Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review. Surg Endosc 32:4707–4715

    Article  Google Scholar 

  15. Mukai T, Nagasaki T, Akiyoshi T et al (2023) The impact of staple transection of the dorsal venous complex and urethra on intraoperative blood loss in cooperative laparoscopic and transperineal endoscopic pelvic exenteration. Surg Today. https://doi.org/10.1007/s00595-023-02693-x

  16. Matsuda T, Sawada R, Hasegawa H et al (2023) Learning curve for transanal total mesorectal excision for low rectal malignancy. J Am Coll Surg 236:1054–1063

    Article  PubMed  Google Scholar 

  17. Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PPA (2016) systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 18:19–36

    Article  CAS  PubMed  Google Scholar 

  18. Imaizumi K, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M (2018) Extended pelvic resection for rectal and anal canal tumors is a significant risk factor for perineal wound infection: a retrospective cohort study. Surg Today 48:978–985

    Article  PubMed  Google Scholar 

  19. Uemura M, Ikeda M, Sekimoto M et al (2009) Prevention of severe pelvic abscess formation following extended radical surgery for locally recurrent rectal cancer. Ann Surg Oncol 16:2204–2210

    Article  PubMed  Google Scholar 

  20. Casey L, Larach JT, Waters PS et al (2022) Application of minimally invasive approaches to pelvic exenteration for locally advanced and locally recurrent pelvic malignancy—a narrative review of outcomes in an evolving field. Eur J Surg Oncol 48:2330–2337

    Article  PubMed  Google Scholar 

  21. Wasmuth HH, Faerden AE, Myklebust TÅ et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–130

    Article  CAS  PubMed  Google Scholar 

  22. Carboni F, Federici O, Giofre’ M, Zazza S, Valle M (2019) Empty pelvis syndrome: the use of breast prosthesis in the prevention of complications. Colorectal Dis 21:1321–1325

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-Tyo, Nishinomiya, Hyogo, 663-8501, Japan

    N. Beppu, K. Ito, M. Otani, A. Imada, T. Matsubara, J. Song, K. Kimura, K. Kataoka & M. Ikeda

  2. Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan

    R. Kuwahara, Y. Horio, M. Uchino & H. Ikeuchi

Authors
  1. N. Beppu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Otani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Imada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. Kataoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Kuwahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Y. Horio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Uchino
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. H. Ikeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KI, MO, AI, TM, JS, and KK. The first draft of the manuscript was written by NB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to N. Beppu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Hyogo Medical University (Approval number 2683) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Consent to participate

Consent to participate from each patient was obtained.

Consent for publication

Consent for publication was obtained.

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 172359 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beppu, N., Ito, K., Otani, M. et al. Feasibility of transanal minimally invasive surgery for total pelvic exenteration for advanced primary and recurrent pelvic malignancies. Tech Coloproctol 27, 1367–1375 (2023). https://doi.org/10.1007/s10151-023-02869-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-023-02869-0

Keywords

Search

Navigation