Excision of the seminal vesicles for locally advanced and recurrent rectal and sigmoid cancer

Keating, John P.; Manning, Stephanie; Dennett, Elizabeth; Studd, Rod

doi:10.1111/ans.13071

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…ERR seems to be a valid option with the partial or complete removal of viscera infiltrated by rectal cancer, sparing uninvolved organs and thus avoiding TPE and the morbidity associated with it. There are various small series of en bloc prostatic wedge resection, total prostatectomy, seminal vesicle excision and urinary bladder wedge resection for locally advanced rectal cancer [14][15][16][17][18][19]. Apart from the current study, Frasson et al [19] compared TPE and ERR recurrence rates.…”

Section: Discussionmentioning

confidence: 92%

Persistent involvement of anterior mesorectal fascia in carcinoma rectum – extended resection of rectum vs total pelvic exenteration: results from a single‐centre retrospective study

et al. 2018

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Section: Discussionmentioning

confidence: 92%

Persistent involvement of anterior mesorectal fascia in carcinoma rectum – extended resection of rectum vs total pelvic exenteration: results from a single‐centre retrospective study

et al. 2018

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“…Keating et al . report on eight such cases in 500 consecutive rectal resections at their tertiary centre 14 . We came across three reports of en‐bloc resection of the seminal vesicles, 15–17 one of which is our own initial experience of two patients 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Keating et al report on eight such cases in 500 consecutive rectal resections at their tertiary centre. 14 We came across three reports of en-bloc resection of the seminal vesicles, [15][16][17] one of which is our own initial experience of two patients. 17 Though rare, this clinical situation offers the unique opportunity of performing an R0 resection with en-bloc resection of one or both seminal vesicles, preserving both the prostate and bladder and more importantly avoiding the morbidity of a cysto-urethral anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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

Desouza

Kazi

Bankar

et al. 2022

ANZ Journal of Surgery

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Background: Isolated seminal vesicle invasion is a rare occurrence in patients with locally advanced rectal cancers. This study describes the surgical technique and the perioperative outcomes of minimally invasive 'en-bloc' seminal vesicle excision, preserving the bladder and the prostate. Methods: A retrospective review of 23 consecutive patients who underwent minimally invasive, en-bloc resection of seminal vesicles for locally advanced, non-metastatic rectal adenocarcinoma between May 2016 and November 2021. Perioperative outcomes and short-term oncological outcomes were defined. Results: Eighteen patients underwent a laparoscopic procedure while five received a robotic resection. All patients received preoperative radiation with or without consolidation chemotherapy. The median age was 42 years (range 20-64 years) and the median hospital stay was 8 days (range 3-19 days), respectively. Serious complications (Clavien-Dindo ≥ IIIb) were seen in six patients (26.1%). Two patients (8.7%) had an involved circumferential resection margin. At a median follow up of 19 months (range 2-52 months), four patients developed recurrences. The 2-year overall and disease-free survival was 84.4% and 73.6%, respectively. Conclusion: Minimally invasive, en-bloc resection of one or both seminal vesicles for locally advanced rectal adenocarcinoma, is feasible in a select group of patients with acceptable morbidity and short-term outcomes.

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“…3 However, following chemoradiotherapy, this fascial plane separating the seminal vesicle from the rectum may not be evident due to fibrosis leading to intentional or unintentional en bloc resection of the seminal vesicles. 4 To the best of our knowledge, the rate of unintentional seminal vesiculectomy has not been reported. Given the atypical appearance of normal seminal vesicle epithelium 5 and the changes in rectal tissue following neoadjuvant CRT, 6 with neoadjuvant CRT and incidental seminal vesiculectomy mimicking residual adenocarcinoma.…”

Section: Introductionmentioning

confidence: 93%

Seminal Vesicle Adherent to Rectal Wall Following Neoadjuvant Chemoradiotherapy: A Potential False-Positive Diagnostic Pitfall

2020

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The standard of care for stage T3 and stage T4 rectal adenocarcinomas involves neoadjuvant chemoradiotherapy followed by either low anterior resection or abdominopelvic resection. The presence of residual adenocarcinoma or positive surgical margins provides useful prognostic information and can influence ongoing adjuvant therapy. Although uncommon, mimics of treated adenocarcinoma may be present in the surgical specimen. A high index of suspicion is critical in avoiding potential false-positive pitfalls, and the exclusion of mimics of treated adenocarcinoma is paramount to accurate diagnosis and treatment. Seminal vesicle epithelium has long been a challenge in differentiating prostatic adenocarcinoma from benign epithelium. However, the role of incidental seminal vesiculectomy in rectal resections due to fibrous adhesion to the rectal wall secondary to chemoradiation has not been studied. As the seminal vesicle epithelium can show markedly atypical nuclei with radiation-type effect at baseline, the potential risk of misinterpretation as residual adenocarcinoma is high. In this article, we present 2 case reports of rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy followed by transabdominal resection (low anterior resection or abdominopelvic resection) with incidental seminal vesiculectomies mimicking either residual adenocarcinoma or residual adenocarcinoma at a margin of resection.

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Excision of the seminal vesicles for locally advanced and recurrent rectal and sigmoid cancer

Abstract: In carefully selected patients with locally advanced or recurrent rectal and sigmoid cancers that are attached to the seminal vesicles, en-bloc excision confers excellent local control but is associated with a high rate of sexual morbidity.

Cited by 5 publications

References 12 publications

Persistent involvement of anterior mesorectal fascia in carcinoma rectum – extended resection of rectum vs total pelvic exenteration: results from a single‐centre retrospective study

Persistent involvement of anterior mesorectal fascia in carcinoma rectum – extended resection of rectum vs total pelvic exenteration: results from a single‐centre retrospective study

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

Seminal Vesicle Adherent to Rectal Wall Following Neoadjuvant Chemoradiotherapy: A Potential False-Positive Diagnostic Pitfall

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