Robotic Partial Excision of the Levator Ani Muscle in Low Rectal Cancer

Functional and perioperative outcome

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This video explained funcional and perioperative outcome after PELM with our data.

Keywords

  • PELM
  • functional outcome
  • perioperative outcome
  • incontinence
  • Wexner
  • MSKCC
  • indication

Conflict of Interest

The author declares no conflict of interest.

References

  1. 1.
    Noh GT, Han J, Cheong C, Han YD, Kim NK (2017) Novel anal sphincter saving procedure with partial excision of levator-ani muscle in rectal cancer invading ipsilateral pelvic floor. Ann Surg Treat Res 93(4):195–202CrossRefGoogle Scholar
  2. 2.
    Lee JM, Kim NK (2018) Essential anatomy of the anorectum for colorectal surgeons focused on the gross anatomy and histologic findings. Ann Coloproctol 34(2):59–71CrossRefGoogle Scholar
  3. 3.
    Yang SY, Kim NK (2020) Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor. Ann Coloproctol.  https://doi.org/10.3393/ac.2020.06.29. Epub ahead of print

About this video

Author(s)
Nam Kyu Kim
First online
30 April 2021
DOI
https://doi.org/10.1007/978-981-33-6124-9_4
Online ISBN
978-981-33-6124-9
Publisher
Springer, Singapore
Copyright information
© Springer Nature Singapore Pte Ltd. 2020

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Video Transcript

Let me talk about the functional and perioperative outcomes up to PELM procedures. This is a 63-year-old lady. She had a, as you can see, the rectal cancer located at the anorectal junction. It involved only the left side of the levator ani muscles.

At the pre-op CRT, good MRI TRG was obtained, and the patients underwent robotic PELM procedures. One and a half years later, a follow-up rectal MRI was done and shown here, the right side. No evidence of local recurrence, and also, we can see the only left side levator ani muscle was absent.

Another case is a 57-year-old gentleman. Rectal cancer was located at the level of the anorectal junction, and it partly involved the right-side levator ani muscles. After long pre-op op chemoradiation therapy, good MR TRG charge was obtained, and the patients underwent PELM procedure, right side.

After PELM procedure, diverting was closed. The patients showed acceptable bowel movement with no fecal incontinence. Followup rectal MRI showed absence of right levator ani muscle in this slide. This is a defecogram of the one case of PELM procedures. Evacuation, and resting, and straining the anorectal angle seems to be acceptable.

This is change of– MSKCC and Wexner score, you have the PELM in one case, and the time goes by. And the Wexner score, the MSKCC score is getting improved. As you can see, so 12 months after the PELM procedures and ileostomy closure, Wexner score is recorded as 11. It is still a high score, but hopefully the score is getting more improved. But MSKCC’s score is only recorded 69. It seems to be really acceptable.

As you can see, the old 23 patients received the PELM procedure. I would like to show that the functional and perioperative outcomes. The distal resection margin was all negative So circumferential resection margin was positive in two patients. I think the two cases are among the early PELM technical period. Regarding the functional outcome, in most cases and Wexner score seems to be acceptable.

Based on my personal experience, PELM procedure could be a surgical treatment option for anorectal junction cancer, which are partly invading the levator ani muscles. But oncology safety is indication should be limited. And the long-term function outcome might be rated more.

Personally, I am convinced that PELM really works in some of the patients. Surprisingly, good function outcome, and five-year no evidence of disease result makes me happy.