Bladder preserving robotic pelvic exenteration for locally advanced rectal cancer‐technique and short‐term outcomes

Abstract

Aim In selected patients with advanced rectal cancers involving the prostate or seminal vesicles, the bladder can be preserved to avoid the complications associated with an ileal conduit. The study was aimed at reviewing the technique and short‐term outcomes of patients that underwent bladder sparing robotic pelvic exenteration with suprapubic cystostomy (SPC). Methods Case series of bladder preserving exenteration from a single tertiary care center. Technique for en‐bloc prostatectomy with abdominoperineal resection is described. Results Five patients underwent bladder sparing robotic pelvic exenteration with SPC, all had R0 resections. Four patients had prostatic invasion and one patient had prostatic adenocarcinoma. Postoperative complications were seen in three patients of which two were re‐explored. At a median follow‐up of 10 months, two patients developed systemic relapses. There were no local recurrences. Conclusion Robotic bladder sparing exenteration is technically feasible, provides acceptable short‐term outcomes, and avoids complications of ileal conduit.

Minimally invasive, ‘en‐bloc’ seminal vesicle excision for locally advanced rectal adenocarcinoma: surgical technique and short‐term outcomes

“…In males, however, a TPE may be required due to loss of planes or frank infiltration of the bladder, seminal vesicles or prostate. In order to avoid the increased morbidity associated with a urinary diversion procedure following TPE, a bladder sparing en‐bloc prostatectomy is feasible 6 . Though the morbidity associated with en‐bloc prostatectomy is less than TPE, it is associated with very high rates of post‐operative urinary leak, which range from 50% to 60.9% 11–13 …”

“…In order to avoid the increased morbidity associated with a urinary diversion procedure following TPE, a bladder sparing en-bloc prostatectomy is feasible. 6 Though the morbidity associated with en-bloc prostatectomy is less than TPE, it is associated with very high rates of postoperative urinary leak, which range from 50% to 60.9%. [11][12][13] Seminal vesicle involvement or abutment in anterior based tumours without involvement of either the prostate or bladder wall is a very rare occurrence.…”

“…Although TPE is the standard surgical option for these patients, less morbid resection templates have been suggested to achieve an R0 resection. 6 There does exist a subgroup of male patients with anteriorly based disease, involving or abutting the seminal vesicles but without bladder or prostatic involvement. In such unique clinical situations, an R0 resection can be achieved by excising one or both seminal vesicles 'en-bloc'with the primary tumour, preserving the urinary bladder and prostate (Fig.…”

“…In male patients, the prostate and seminal vesicles are the most common organs to be involved with anteriorly based, T4 tumours. Although TPE is the standard surgical option for these patients, less morbid resection templates have been suggested to achieve an R0 resection 6 . There does exist a subgroup of male patients with anteriorly based disease, involving or abutting the seminal vesicles but without bladder or prostatic involvement.…”

Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers

“…Non-multivisceral resection or those requiring partial organ resections are categorized as extended TME and were not included. Thus, total pelvic exenterations [ 2 ], bladder sparing exenterations [ 14 ], and posterior pelvic exenterations were the operations performed [ 15 ], with or without sacral or perineal resections. The techniques for each of these are previously described, and all operations were performed by the same team of surgeons.…”