Robotic pelvic exenteration and extended pelvic resections for locally advanced or synchronous rectal and urological malignancy

Abstract

Purpose: To describe the surgical technique and examine the feasibility and outcomes following robotic pelvic exenteration and extended pelvic resection for rectal and/or urological malignancy.

Materials and methods: We present a case series of seven patients with locally advanced or synchronous urological and/or rectal malignancy who underwent robotic total or posterior pelvic exenteration between 2012-2016.

Results: In total, we included seven patients undergoing pelvic exenteration or extended pelvic resection. The mean operative time was 485±157 minutes and median length of stay was 9 days (6-34 days). There was only one Clavien-Dindo complication grade 3 which was a vesicourethral anastomotic leak requiring rigid cystoscopy and bilateral ureteric catheter insertion. Eighty-five percent of patients had clear colorectal margins with a median margin of 3.5 mm (0.7-8.0 mm) while all urological margins were clear. Six out of seven patients had complete (grade 3) total mesorectal excision. Three patients experienced recurrence at a median of 22 months (21-24 months) post-operatively. Of the three recurrences, one was systemic only whilst two were both local and systemic. One patient died from complications of dual rectal and prostate cancer 31 months after the surgery.

Conclusions: We report a large series examining robotic pelvic exenteration or extended pelvic resection and describe the surgical technique involved. The robotic approach to pelvic exenteration is highly feasible and demonstrates acceptable peri-operative and oncological outcomes. It has the potential to benefit patients undergoing this highly complex and morbid procedure.

Keywords: Colorectal cancer; Minimally invasive surgical procedures; Pelvic exenteration; Prostate cancer; Surgery.

Fig. 1. En bloc resection combining abdominoperineal resection and cystoprostatectomy, right posterior pedicle dissection.

Fig. 2. In case of ultra-low anterior resection with colo-anal anastomosis, an omental flap is inserted between the both digestive and urinary fistula. (A) First, the omental flap is tunneled posteriorly to the bladder toward the pelvis. (B) Then the omental flap is sutured anterior to the colo-anal anastomosis before performing the urethra-vesical anastomosis.