Laparoscopic Total Pelvic Exenteration for Locally Recurrent Rectal Cancer

Abstract

Background

Extended surgery for locally recurrent rectal cancer is technically demanding because of the severe fibrosis around the tumor, which makes it difficult to achieve R0 resection. Although laparoscopic total pelvic exenteration has been carried out in patients with primary rectal cancer,1 , 2 to our knowledge ours is the first report of this laparoscopic procedure for locally recurrent rectal cancer.

Methods

A 70-year-old man who underwent laparoscopic low anterior resection for stage II rectal cancer was diagnosed as having two separate local recurrences near the anastomotic site. We decided to perform laparoscopic total pelvic exenteration after neoadjuvant chemoradiotherapy. The branches of the internal iliac vessels were carefully identified and divided. Presacral dissection behind the neorectum was carried out above the anastomotic site. Ligation of the dorsal vein complex was performed under direct visualization, with the patient in the jack-knife position. The perineal defect was reconstructed using a bilateral V–Y advancement of the musculocutaneous flaps of the gluteus maximus. An ileal conduit was constructed extracorporeally via an umbilical incision, after placing the patient in the lithotomy position.

Results

The total operative time was 18 h and 5 min, with an estimated blood loss of 750 mL. Final pathology showed negative resection margins.

Conclusions

Laparoscopic total pelvic exenteration for locally recurrent rectal cancer is a technically challenging procedure requiring a long operative time. However, as demonstrated by this case, it can provide a very clear view of the operative field, allowing precise dissection, less blood loss, and a smaller abdominal wound.

References

  1. 1.

    Mukai T, Akiyoshi T, Ueno M, et al. Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer. Asian J Endosc Surg. 2013;6:314–17.

    Article  PubMed  Google Scholar 

  2. 2.

    Patel H, Joseph JV, Amodeo A, Kothari K. Laparoscopic salvage total pelvic exenteration: is it possible post-chemo-radiotherapy? J Minim Access Surg. 2009;5:111–14.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

Download references

Disclosure

The authors have no potential conflicts of interest.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Takashi Akiyoshi MD, PhD.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 140054 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Akiyoshi, T., Nagasaki, T. & Ueno, M. Laparoscopic Total Pelvic Exenteration for Locally Recurrent Rectal Cancer. Ann Surg Oncol 22, 3896 (2015). https://doi.org/10.1245/s10434-015-4473-8

Download citation

Keywords

  • Rectal Cancer
  • Anastomotic Site
  • Total Operative Time
  • Ileal Conduit
  • Gluteus Maximus