Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2020; 12(4): 190-196
Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.190
Feasibility of robotic assisted bladder sparing pelvic exenteration for locally advanced rectal cancer: A single institution case series
Nathaniel H Heah, Kar Yong Wong
Nathaniel H Heah, Department of Urology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Kar Yong Wong, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Wong KY and Heah NH all designed and performed research, analysed data, and wrote the paper.
Institutional review board statement: The study was reviewed and approved by National Healthcare Group Domain Specific Review Board. NHG DSRB Ref: 2018/01054.
Informed consent statement: Patients were not required to give informed consent to the study because analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interests to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kar Yong Wong, FRCS (Ed), FRCS (Gen Surg), MBChB, Surgeon, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. kar_yong_wong@ttsh.com.sg
Received: December 20, 2019
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
Abstract
BACKGROUND

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.

AIM

To determine the feasibility of robotic assisted bladder sparing pelvic exenteration.

METHODS

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.

RESULTS

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

CONCLUSION

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.

Keywords: Rectal cancer, Robot surgery, Pelvic exenteration, Anterior resection, Prostatectomy, Minimal 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.