Kehagias D, Lampropoulos C, Kehagias I. Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer: A glimpse into the future. World J Gastrointest Surg 2024; 16(7): 1960-1964 [PMID: 39087129 DOI: 10.4240/wjgs.v16.i7.1960]
Corresponding Author of This Article
Dimitrios Kehagias, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, General University Hospital of Patras, Rion, Patras 26504, Greece. dimikech@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2024; 16(7): 1960-1964 Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.1960
Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer: A glimpse into the future
Dimitrios Kehagias, Charalampos Lampropoulos, Ioannis Kehagias
Dimitrios Kehagias, Department of General Surgery, General University Hospital of Patras, Patras 26504, Greece
Charalampos Lampropoulos, Intensive Care Unit, Saint Andrew’s General Hospital, Patras 26335, Greece
Ioannis Kehagias, Division of Bariatric and Metabolic Surgery, Department of Surgery, University of Patras, Patras 26504, Greece
Author contributions: Kehagias I designed the overall concept and outline of the manuscript; Lampropoulos C contributed to the discussion and design of the manuscript; Kehagias D and Kehagias I contributed to writing and editing the manuscript, creating the tables, and reviewing the literature.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Kehagias, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, General University Hospital of Patras, Rion, Patras 26504, Greece. dimikech@gmail.com
Received: February 29, 2024 Revised: May 4, 2024 Accepted: May 21, 2024 Published online: July 27, 2024 Processing time: 143 Days and 17 Hours
Abstract
Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer (LARC) for many years. Their main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative complications. Currently, pelvic exenteration (PE) with or without neoadjuvant treatment is a curative treatment when negative resection margins are achieved. The traditional open approach has been favored by many surgeons. However, the technological advancements in minimally invasive surgery have radically changed the surgical options. Recent studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE. A recent retrospective study entitled “Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer: A 9-year review” was published in the World Journal of Gastrointestinal Surgery. As we read this article with great interest, we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for LARC. Currently, the small number of suitable patients, limited surgeon experience, and steep learning curve are hindering the establishment of minimally invasive PE.
Core Tip: Minimally invasive and robotic pelvic exenteration (PE) is currently feasible in appropriately selected locally advanced rectal cancer patients. It is associated with decreased postoperative complications and promising oncological outcomes. The disadvantages of establishing minimally invasive PE as the gold standard treatment for these patients are the relatively small sample sizes in studies, the limited experience of surgeons, and the lack of long-term data on oncological outcomes. Additional well-designed studies with larger sample sizes and long-term data are needed to establish the benefits of the robotic and laparoscopic approaches for PE.
