Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.190
Peer-review started: December 20, 2019
First decision: January 6, 2020
Revised: March 12, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 27, 2020
Pelvic exenteration for locally advanced rectal cancer involving prostate has been performed via open surgery. Robotic pelvic exenteration offers benefits of better pelvic visualisation and dissection for bladder preserving prostatectomy with vesicourethral anastomosis, while achieving clear margins.
To determine the feasibility of robotic assisted bladder sparing pelvic exenteration.
We describe robotic assisted pelvic exenteration in three cases of locally advanced rectal cancer involving prostate and seminal vesicles (SV). The da Vinci S robotic system was used. Robotic console was docked at left oblique position for abdominal phase and redocked to between the patient’s legs for pelvic phase. All three cases were performed fully robotically at Tan Tock Seng Hospital by colorectal and urological teams.
Case 1: 67-year-old with low rectal tumour 3cm from anal verge involving the prostate. He underwent neo-adjuvant chemoradiotherapy and robotic abdominoperineal resection with en-bloc prostatectomy. Case 2: 66-year-old with low rectal tumour 3cm from anal verge involving prostate and bilateral SV. He underwent neo-adjuvant chemoradiotherapy and robot assisted ultra-low anterior resection with coloanal anastomosis and en-bloc prostatectomy. Case 3: 57-year-old with metachronous rectal tumour in the rectovesical pouch inseparable from the anterior mid rectum, prostate and bilateral SV. He underwent robot assisted ultra-low anterior resection with en-bloc prostatectomy. Bladder neck margin revealed cauterized tumour cells, and he underwent total cystectomy and ileal conduit creation. Histology revealed no residual tumour. All patients are currently disease free
Robot assisted bladder sparing pelvic exenteration can be safely performed in locally advanced rectal cancer with acceptable surgical outcome while preserving benefits of minimally invasive surgery.
Core tip: This paper adds on to the current evidence on feasibility of robotic surgery in pelvic exenteration for locally advanced rectal cancer. Studies on minimal invasive surgery for bladder sparing prostatectomy in rectal cancer scarce. Such extensive disease frequently requires total pelvic exenteration with ileal conduit formation. Our experience shows that minimal invasive surgery pelvic exenteration can be achieved using robotic surgery with good oncological outcome while at the same time, allows preservation of urinary and bowel function. This will encourage surgeons to consider the usage of robotic surgery in pelvic exenteration for rectal cancer.