Robotic Pelvic Exenteration
There has been significant growth in the use of robotic surgery for rectal cancer worldwide. Emerging data appears to support the feasibility of robotic surgery for T4 rectal cancers with comparable short-term oncologic outcomes. The advantages of robotic surgery over conventional laparoscopic surgery include better pelvic visualization by 3-D-adjustable cameras and more degrees of freedom with wrist-articulated instrumentation, thus achieving more precise dissections. These benefits may compensate for some of the limitations of conventional laparoscopic surgery, especially during complex pelvic dissection. In carefully selected cases, the robotic approach may expand our ability to offer minimally invasive surgery to this subset of locally advanced rectal cancer patients. In this chapter, we clarify a step-by-step approach of robotic pelvic exenteration for T4 rectal cancers.
KeywordsRectal cancer Adenocarcinoma of the rectum Pelvic exenteration Robotic surgery Minimally invasive surgery for rectal cancer Colorectal cancer
Video demonstrates a step-by-step approach for robotic total pelvic exenteration in a patient who had low rectal cancer with prostatic invasion (MOV 662715 kb)
- 1.Jemal A, Ward EM, Johnson CJ, et al. Annual report to the nation on the status of cancer, 1975–2014, featuring survival. J Natl Cancer Inst. 2017;109(9). https://doi.org/10.1093/jnci/djx030.
- 6.Levy M, Lipska L, Visokai V, et al. Quality of life after extensive pelvic surgery. Rozhledy v chirurgii: mesicnik Ceskoslovenske chirurgicke spolecnosti. 2016;95:358–462.Google Scholar
- 7.Beyond TME Collaborative. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg. 2013;100:1009–14.Google Scholar
- 23.Colombo PE, Bertrand MM, Alline M, et al. Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal TME rectal approach?: a single-center series of 120 consecutive patients. Ann Surg Oncol. 2016;23:1594–600.CrossRefGoogle Scholar
- 30.Beyond TME Collaborative. Surgical and survival outcomes following pelvic exenteration for locally advanced primary rectal cancer: results from an international collaboration. Ann Surg. 2017;269(2):315–21.Google Scholar