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Feasibility of robotic assisted bladder sparing pelvic exenteration for locally advanced rectal cancer:A single institution case series

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World Journal of Gastrointestinal Surgery 2020年第4期12卷 190-196页

作者： Nathaniel H Heah Kar Yong Wong Department of Urology Tan Tock Seng HospitalSingapore 308433Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

BACKGROUND Pelvic exenteration for locally advanced rectal cancer involving prostate has been performed via open *** pelvic exenteration offers benefits of better pelvic visualisation and dissection for bladder preserving prostatectomy with vesicourethral anastomosis,while achieving clear *** To determine the feasibility of robotic assisted bladder sparing pelvic *** 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 *** console was docked at left oblique position for abdominal phase and redocked to between the patient’s legs for pelvic *** three cases were performed fully robotically at Tan Tock Seng Hospital by colorectal and urological *** Case 1:67-year-old with low rectal tumour 3 cm from anal verge involving the *** underwent neo-adjuvant chemoradiotherapy and robotic abdominoperineal resection with en-bloc *** 2:66-year-old with low rectal tumour 3 cm from anal verge involving prostate and bilateral *** underwent neo-adjuvant chemoradiotherapy and robot assisted ultra-low anterior resection with coloanal anastomosis and en-bloc *** 3:57-year-old with metachronous rectal tumour in the rectovesical pouch inseparable from the anterior mid rectum,prostate and bilateral *** underwent robot assisted ultra-low anterior resection with en-bloc *** neck margin revealed cauterized tumour cells,and he underwent total cystectomy and ileal conduit *** revealed no residual *** 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.

关键词： Rectal cancer Robot surgery Pelvic exenteration Anterior resection Prostatectomy Minimal invasive surgery

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Application of robot-assisted laparoscopic pelvic exenteration in treating gynecologic malignancies

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Chinese Medical Journal 2019年第8期132卷 976-979页

作者： Qi-Yu Yang Jun-Ying Tang Department of Gynecology The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400000China.

Introduction Pelvic exenteration(PE)refers to the en bloc resection of the involved pelvic organs along with pelvic reconstruction so as to enhance the survival rate for tumor *** reported by Brunschwig in 1948,[1]PE has thereafter been utilized to treat rectal cancer,bladder cancer,prostate cancer,and cervical cancer as a curative or palliative treatment for advanced or recurrent *** is critical to carry out surgical resection of all the involved tumor lesions so as to prolong the overall survival(OS)of patients;nonetheless,such medical manipulation will induce various *** patients undergoing radiotherapy in the initial treatment,the increased tissue fragility,together with inflammation,has become trouble intraoperatively.

关键词： gynecologic malignancies robot-assisted laparoscopic pelvic exenteration Pelvic exenteration(PE)

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Pelvic exenterations for primary rectal cancer:Analysis from a 10-year national prospective database

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World Journal of Gastroenterology 2018年第45期24卷 5144-5153页

作者： Gianluca Pellino Sebastiano Biondo Antonio Codina Cazador JoséMaría Enríquez-Navascues Eloy Espín-Basany Jose Vicente Roig-Vila Eduardo García-Granero Colorectal Unit Hospital Universitario y Politecnico La FeUniversity of ValenciaValencia 46026Spain Department of General and Digestive Surgery Colorectal UnitBellvitge University HospitalUniversity of Barcelona and IDIBELLL’Hospitalet de LlobregatBarcelona 08907Spain Department of General and Digestive Surgery--Colorectal Unit Josep Trueta University HospitalGirona 17001Spain General and Digestive Surgery Department Donostia University HospitalDonostia 20014Spain Department of General Surgery Colorectal Surgery UnitHospital Valle de HebronAutonomous University of BarcelonaBarcelona 08035Spain Unit of Coloproctology Hospital Vithas-Nisa 9 de OctubreValencia 46015Spain

AIM To identify short-term and oncologic outcomes of pelvic exenterations(PE) for locally advanced primary rectal cancer(LAPRC) in patients included in a national prospective *** Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Espa?ola de Cirujanos(AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence(LR), disease-free survival(DFS) and overall survival(OS). A propensitymatched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary *** Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication(abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio(HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival(HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar *** PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.

关键词： Pelvic exenteration Advanced rectal cancer Colorectal surgery Complication Outcome

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Technical feasibility of laparoscopic extended surgerybeyond total mesorectal excision for primary or recurrentrectal cancer

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World Journal of Gastroenterology 2016年第2期22卷 718-726页

作者： Takashi Akiyoshi Gastroenterological Center Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyo 135-8550Japan

Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal ***, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.

关键词： Rectal cancer Total mesorectal excision Laparoscopic surgery Extended surgery Lateral pelviclymph node dissection Pelvic exenteration

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Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer:A review

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World Journal of Clinical Oncology 2017年第3期8卷 249-254页

作者： Boris Schiltz Nicolas Christian Buchs Marta Penna Cosimo Riccardo Scarpa Emilie Liot Philippe Morel Frederic Ris Division of Visceral Surgery Department of SurgeryUniversity Hospitals of Geneva Department of Colorectal Surgery Churchill HospitalOxford University Hospitals

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal *** large wounds are prone to infection and perineal herniation,and their closure is a major concern to most *** approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous *** technique has its own associated advantages and potential complications and the ideal approach is still *** the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound *** evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap *** addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different ***,it is an easy and quick reconstruction *** more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.

关键词： Biological mesh Rectal cancer Pelvic exenteration Abdominoperineal resection Primary perineal wound closure Perineal wound infection Perineal hernia

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STATUS OF SURGICAL TREATMENT OF RECTAL CANCER IN CHINA

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Medical Bulletin of Shanghai Jiaotong University 1990年第1期13卷 30-36页

作者：周锡庚 Section of Colorectal Surgery Department of Surgery Ruijin Hospital SSMU Shanghai

The multimodality treatment methods of rectal cancer in China are presented. Extended radical excisions are used for Dukes’ B and C cases to reduce local recurrence. These include: high ligation with clearance of proximal lymph nodes at origin of inferior mesenteric artery, lateral pelvic lymphadenectomy, posterior or total pelvic exenterations in selected cases; but controversy exists. Radical sphincter-saving resections are advocated to improve the quality of life. Prerequisites of sphincter-saving resection are adequate resection of bowel and mesentery distal to the lesion, depending on the macroscopic type of lesion and degree of differentiation. The decisive factor in the choice of type of operation is the length of rectal stump above levator ani after resection. Bacon’s pull through resection was modified by preservation of levator ani and dentate margin, much better functional results were obtained postoperatively. Transanal full thickness local excision is advocated for small, protuberant, mobile, well differentiated lesions below the peritoneal reflection. Pre- or postoperative adjuvant radiation therapy is sometimes used for Dukes’ B and C cases. Adjuvant 5-Fu chemotherapy is usually used intraoperatively (intraluminal) or postoperatively (intravenous). The superiority of preoperative intrarectal 5-Fu emulsionover the conventional intravenous route has been demonstrated by experimental and clinical studies, which showed much higher and lasting concentration of 5-Fu in the rectal wall tissues and mesenteric lymph nodes, and a much lower concentration of 5-Fu in bone marrow after intrarectal administration. Several surgical groups employed varying techniques of sphincteric reconstruction of perineal colostomy after abdominoperineal excision, utilizing the gracilis or gluteus maximus sling, or intussusception of the colonic stump; with favorable late results in reported cases. However, controversy exists, so strict appropriate case selection is emphasized to

关键词： colorectal cancer lateral pelvic lymphadenectomy pelvic exenteration radical sphincter-saving resections local excision adjuvant therapy preoperative intrarectal 5-Fu perineal colostomy with sphincteric reconstruction

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Epidemiological Particularities and Indications of the Mutilating Surgery of the Eyeball in Abidjan (Ivory Coast)

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Open Journal of Ophthalmology 2018年第2期8卷 91-96页

作者： Sowagnon Thierry Yves Constant Bilé Philippe Emile France Koffi Irie Bi Gohi Serge Koman Chatsé Ellalie Diomandé Gossé Francois Kra Alla N’goran Simé on Konan Manmi Sienou Marguerite Pascaline Dé tchi Honorat Koné Safé dé Kouassi Francois Xavier Ophthalmology Department of the University Hospital Center of Yopougon Yopougon Ivory Coast Ophthalmology Department of the University Hospital Center of Bouake Bouake Ivory Coast Anesthesia and Resuscitation Department of the University Hospital Center of Bouake Bouake Ivory Coast Ophthalmology Department of the University Hospital Center of Cocody Cocody Ivory Coast

Objective: To describe the epidemiological profile and indications of mutilating eyeball surgery in Abidjan. Patients and methods: This is a retrospective descriptive study on the files of eviscerated, enucleated or exentered patients in the Ophthalmology Department of the University Hospital of Yopougon from January 2010 to December 2016. The parameters studied were: socio-demographic characteristics, indications of mutilating surgery, anesthetic technique, operative technique and patient evolution. Results: During the study period, 59 patients underwent surgery for mutilating eye surgery out of a total of 11,114 procedures, a frequency of 0.53%. The average age of the patients was 31 years with extremes of 3 years and 67 years. Men predominated in 62.1% of cases with a sex ratio of 1.64. Patients came from rural areas in 68.5% of cases. The main indications of the mutilating surgery were: post-inflammatory phthisis (58.6%) and tumoral affections (29.31%). Evisceration was the most common operative technique (67.2%). In 68% of cases the interventions were performed under peribulbar anesthesia. Patients with evisceration (67.2%) and enucleation (5.1%) all benefited from prosthetic equipment. Conclusion: The mutilating surgery of the eyeball is responsible for serious psychological and sociological impacts. The seriousness of these repercussions requires primary prevention through early and adequate management of eye conditions.

关键词： Mutilating Surgery Anesthesia Evisceration Enucleation exenteration

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全盆腔脏器切除术

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医学信息（医学与计算机应用） 2014年第10期18卷 498-499页

作者：肖大春魏正强重庆医科大学附属第一医院胃肠外科重庆400016

1简介全盆腔脏器切除术(Total Pelvic exenteration)是指切除盆腔肿瘤及盆腔全部脏器的一种手术方式,包括盆腔肿块、内生殖器官、膀胱、远侧输尿管、直肠及部分乙状结肠、转移淋巴结、盆底腹膜、提肛肌及外阴,并做消化道及尿路重建。该... 详细信息

1简介全盆腔脏器切除术(Total Pelvic exenteration)是指切除盆腔肿瘤及盆腔全部脏器的一种手术方式,包括盆腔肿块、内生殖器官、膀胱、远侧输尿管、直肠及部分乙状结肠、转移淋巴结、盆底腹膜、提肛肌及外阴,并做消化道及尿路重建。该术式能在一定程度上提高晚期盆腔肿瘤患者的生存率,被认为适用于盆腔肿瘤复发、放疗后并发症、肿瘤姑息性治疗伴有严重盆腔症状者,但远处转移被视为该术式的禁忌症。对于盆腔肿瘤患者,需要严格筛选来执行该手术,以提高治愈率及减少术后并发症。

关键词：盆腔肿瘤 Pelvic exenteration 肿瘤患者全盆腔脏器切除术术后并发症转移淋巴结姑息性治疗肿瘤复发远处转移乙状结肠术式手术方式生殖器官盆腔肿块盆底腹膜尿路重建高治愈率消化道提肛肌输尿管

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