Feasibility of transperineal minimal invasive surgery when performing sacrectomy for advanced primary and recurrent pelvic malignancies.
Humans
Female
Middle Aged
Feasibility Studies
Aged
Neoplasm Recurrence, Local
Retrospective Studies
Male
Perineum
/ surgery
Minimally Invasive Surgical Procedures
/ methods
Adult
Treatment Outcome
Pelvic Neoplasms
/ surgery
Sacrum
/ surgery
Pelvic Exenteration
/ methods
Rectal Neoplasms
/ surgery
Postoperative Complications
/ etiology
Ovarian Neoplasms
/ surgery
Extended pelvic surgery
Pelvic malignancies
Sacrectomy
Transperineal minimally invasive surgery
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
06 Jul 2024
06 Jul 2024
Historique:
received:
08
02
2024
accepted:
08
06
2024
medline:
7
7
2024
pubmed:
7
7
2024
entrez:
6
7
2024
Statut:
epublish
Résumé
This study aimed to clarify the efficacy and safety of minimally invasive transabdominal surgery (MIS) with transperineal minimal invasive surgery (tpMIS) for sacrectomy in advanced primary and recurrent pelvic malignancies. Using a prospectively collected database, we retrospectively analyzed the clinical, surgical, and pathological outcomes of MIS with tpMIS for sacrectomies. Surgery was performed between February 2019 and May 2023. The median follow-up period was 27 months (5-46 months). Fifteen consecutive patients were included in this analysis. The diagnoses were as follows: recurrent rectal cancer, n = 11 (73%); primary rectal cancer, n = 3 (20%); and recurrent ovarian cancer, n = 1 (7%). Seven patients (47%) underwent pelvic exenteration with sacrectomy, six patients (40%) underwent abdominoperineal resection (APR) with sacrectomy, and two patients (13%) underwent tumor resection with sacrectomy. The median intraoperative blood loss was 235 ml (range 45-1320 ml). The postoperative complications (Clavien-Dindo grade ≥ 3a) were graded as follows: 3a, n = 6 (40%); 3b, n = 1 (7%); and ≥ 4, n = 0 (0%). Pathological examinations demonstrated that R0 was achieved in 13 patients (87%). During the follow-up period, two patients (13%) developed local re-recurrence due to recurrent cancer. The remaining 13 patients (87%) had no local disease. Fourteen patients (93%) survived. Although the patient cohort in this study is heterogeneous, MIS with tpMIS was associated with a very small amount of blood loss, a low incidence of severe postoperative complications, and an acceptable R0 resection rate. Further studies are needed to clarify the long-term oncological feasibility.
Sections du résumé
BACKGROUND
BACKGROUND
This study aimed to clarify the efficacy and safety of minimally invasive transabdominal surgery (MIS) with transperineal minimal invasive surgery (tpMIS) for sacrectomy in advanced primary and recurrent pelvic malignancies.
METHODS
METHODS
Using a prospectively collected database, we retrospectively analyzed the clinical, surgical, and pathological outcomes of MIS with tpMIS for sacrectomies. Surgery was performed between February 2019 and May 2023. The median follow-up period was 27 months (5-46 months).
RESULTS
RESULTS
Fifteen consecutive patients were included in this analysis. The diagnoses were as follows: recurrent rectal cancer, n = 11 (73%); primary rectal cancer, n = 3 (20%); and recurrent ovarian cancer, n = 1 (7%). Seven patients (47%) underwent pelvic exenteration with sacrectomy, six patients (40%) underwent abdominoperineal resection (APR) with sacrectomy, and two patients (13%) underwent tumor resection with sacrectomy. The median intraoperative blood loss was 235 ml (range 45-1320 ml). The postoperative complications (Clavien-Dindo grade ≥ 3a) were graded as follows: 3a, n = 6 (40%); 3b, n = 1 (7%); and ≥ 4, n = 0 (0%). Pathological examinations demonstrated that R0 was achieved in 13 patients (87%). During the follow-up period, two patients (13%) developed local re-recurrence due to recurrent cancer. The remaining 13 patients (87%) had no local disease. Fourteen patients (93%) survived.
CONCLUSIONS
CONCLUSIONS
Although the patient cohort in this study is heterogeneous, MIS with tpMIS was associated with a very small amount of blood loss, a low incidence of severe postoperative complications, and an acceptable R0 resection rate. Further studies are needed to clarify the long-term oncological feasibility.
Identifiants
pubmed: 38971941
doi: 10.1007/s10151-024-02954-y
pii: 10.1007/s10151-024-02954-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
80Informations de copyright
© 2024. Springer Nature Switzerland AG.
Références
Uehara K, Ito Z, Yoshino Y et al (2015) Aggressive surgical treatment with bony pelvic resection for locally recurrent rectal cancer. Eur J Surg Oncol 41:413–420
doi: 10.1016/j.ejso.2014.11.005
pubmed: 25477268
Sasikumar A, Bhan C, Jenkins JT, Antoniou A, Murphy J (2017) Systematic review of pelvic exenteration with en bloc sacrectomy for recurrent rectal adenocarcinoma: R0 resection predicts disease-Free survival. Dis Colon Rectum 60:346–352
doi: 10.1097/DCR.0000000000000737
pubmed: 28177998
Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210
doi: 10.1007/s00464-010-0965-6
pubmed: 20186432
Lacy AM, Tasende MM, Delgado S et al (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221:415–423
doi: 10.1016/j.jamcollsurg.2015.03.046
pubmed: 26206640
González-Abós C, de Lacy FB, Guzmán Y et al (2021) Transanal total mesorectal excision for stage II or III rectal cancer: pattern of local recurrence in a tertiary referral center. Surg Endosc 35:7191–7199
doi: 10.1007/s00464-020-08200-4
pubmed: 33398553
Hayashi K, Kotake M, Kakiuchi D et al (2016) Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer. Surg Case Rep 2:74
doi: 10.1186/s40792-016-0198-6
pubmed: 27460130
pmcid: 4961659
Ohno R, Matsumoto Y, Nagano H et al (2022) Combined laparoscopic and transperineal endoscopic total pelvic exenteration for the vaginal stump recurrence of cervical cancer. J Gynecol Oncol 33(1):e16
doi: 10.3802/jgo.2022.33.e16
pubmed: 34910397
Beppu N, Ito K, Otani M et al (2023) Feasibility of transanal minimally invasive surgery for total pelvic exenteration for advanced primary and recurrent pelvic malignancies. Tech Coloproctol 27:1367–1375
doi: 10.1007/s10151-023-02869-0
pubmed: 37878167
Kimura K, Ikeda M, Kataoka K et al (2020) Sacrectomy for recurrent rectal cancer using the transanal total mesorectum excision technique. Dis Colon Rectum 63:e566–e573
doi: 10.1097/DCR.0000000000001794
pubmed: 33149027
Uemura M, Ikeda M, Kawai K et al (2018) Laparoscopic surgery using a Gigli wire saw for locally recurrent rectal cancer with concomitant intraperitoneal sacrectomy. Asian J Endosc Surg 11:83–86
doi: 10.1111/ases.12407
pubmed: 29485249
Mangram AJ, Horan TC, Pearson ML et al (1999) Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 27:97–132
doi: 10.1016/S0196-6553(99)70088-X
pubmed: 10196487
Japanese Society for Cancer of the Colon and Rectum (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma: 3rd English edition. J Anus Rectum Colon 3:175–195
Milne T, Solomon MJ, Lee P et al (2014) Sacral resection with pelvic exenteration for advanced primary and recurrent pelvic cancer: a single-institution experience of 100 sacrectomies. Dis Colon Rectum 57:1153–1161
doi: 10.1097/DCR.0000000000000196
pubmed: 25203370
Imaizumi K, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M (2018) Extended pelvic resection for rectal and anal canal tumors is a significant risk factor for perineal wound infection: a retrospective cohort study. Surg Today 48:978–985
doi: 10.1007/s00595-018-1680-5
pubmed: 29858669
Ogawa H, Uemura M, Nishimura J et al (2015) Preoperative chemoradiation followed by extensive pelvic surgery improved the outcome of posterior invasive locally recurrent rectal cancer without deteriorating surgical morbidities: a retrospective, single-institution analysis. Ann Surg Oncol 22:4325–4334
doi: 10.1245/s10434-015-4452-0
pubmed: 25893408
Koh CE, Solomon MJ, Brown KG et al (2017) The evolution of pelvic exenteration practice at a single center: lessons learned from over 500 cases. Dis Colon Rectum 60:627–635
doi: 10.1097/DCR.0000000000000825
pubmed: 28481857
Verweij ME, Hoendervangers S, von Hebel CM, Pronk A, Schiphorst AHW, et al.WMU, Intven MPW (2023) Patient- and physician-reported radiation-induced toxicity of short-course radiotherapy with a prolonged interval to surgery for rectal cancer. Colorectal Dis 25:24–30
doi: 10.1111/codi.16315
pubmed: 36054676
Beppu N, Ikeda M, Kimura K et al (2020) Extended total mesorectal excision based on the avascular planes of the retroperitoneum for locally advanced rectal cancer with lateral pelvic sidewall invasion. Dis Colon Rectum 63:1475–1481
doi: 10.1097/DCR.0000000000001788
pubmed: 32969892
Sun Y, Yang H, Zhang Z et al (2022) Fascial space priority approach for laparoscopic total pelvic exenteration in patients with locally advanced rectal cancer. Surg Endosc 36:6331–6335
doi: 10.1007/s00464-022-09216-8
pubmed: 35411456
Beppu N, Jihyung S, Takenaka Y et al (2021) Laparoscopic lateral pelvic lymph node dissection combined with removal of the internal iliac vessels in rectal cancer: how to standardize this surgical procedure. Tech Coloproctol 25:579–587
doi: 10.1007/s10151-020-02387-3
pubmed: 33650084