Robotic Site Adjusted Levator Transection for Carcinoma of the Rectum: A Modification of the Existing Cylindrical Abdominoperineal Resection for Eccentrically Located Tumors
- 218 Downloads
Today, extralevator abdominoperineal resection is the standard of care for low rectal cancers with sphincter involvement or location precluding anastomosis. This procedure, while effective from an oncologic point of view, is morbid, with a high incidence of wound complications and genitourinary, and sexual dysfunction. We present a modification of this procedure via a robotic approach, which maintains the radicality while reducing the soft tissue loss and potentially the morbidity.
Over a 2-year period, five patients (four men and one woman) with eccentric low rectal cancers following neoadjuvant chemoradiation underwent a robot-assisted modified abdominoperineal resection with wide levator transection on the tumor side and conservative levator division on the opposite side. These patients were prospectively followed. Perioperative outcomes, pathologic specimen measures, wound-related problems, and local and systemic recurrences were documented and analyzed.
All procedures were successfully completed without conversion. Average body mass index was 32 kg/m2. The mean operative time and blood loss were 370 min and 130 ml, respectively. All specimens had an intact mesorectal envelope with no tumor perforations, and the mean lymph node yield was 16. There were no urinary complications or perineal wound infections. At a median follow-up of 14 months, all patients remain disease-free.
Modified robotic cylindrical abdominoperineal resection with site adjusted levator transection for rectal cancer is an oncologically sound operation in eccentrically located tumors. It maintains the radicality of conventional extralevator abdominoperineal resection, while also reducing the soft tissue loss and thereby potentially the morbidity.
KeywordsAbdominoperineal Resection Circumferential Resection Margin Perineal Herniation Tumor Perforation Perineal Wind
Drs. Ajit Pai and George Melich would like to thank the Foundation for Surgical Fellowships for providing the opportunity to undergo fellowship training in the institution of affiliation.
Compliance with ethical standards
Conflict of interest
There was no source of funding for this paper. Ajit Pai, Saleh M. Eftaiha, George Melich, John J Park, Pey-yi Kevin Lin, Leela M Prasad, and Slawomir J Marecik have no conflict of interest or financial ties to disclose.
Supplementary material 1 (MP4 20508 kb)
Supplementary material 2 (MP4 20402 kb)
Supplementary material 3 (MP4 19043 kb)