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

Abstract

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.

Comparing robotic with laparoscopic beyond total mesorectal excision for advanced rectal cancer—a propensity‐matched analysis

“…Quadrant‐wise resections beyond the TME plane were carried out based on the location of the tumour involving the MRF or surrounding pelvic structures. Briefly, we describe surgeries as exenterations when the entire urogenital organ was resected (prostate, bladder or uterus) [12] and as extended TME when surrounding soft tissue, bone, neurovascular structure or partial organ resection was performed en bloc with the TME as per a previously published description [13, 14]. Lateral pelvic lymph node dissection (LPLND) was reserved for enlarged nodes (≥7 mm short‐axis diameter) that persisted despite preoperative radiation (≥4 mm short‐axis diameter) [15].…”

Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer

“…We hereby propose an anatomical quadrant‐based classification of the surgical procedures performed in eTME. The anterior quadrant surgical procedures included posterior vaginal wall excision, prostatic shave, bladder peritonectomy, partial cystectomy and seminal vesicle excision 12 The posterior quadrant surgical procedures included excision of presacral fascia. The lateral quadrant surgical procedures included removal of the hypogastric nerves, vascular approach resections involving the partial resections of lateral pelvic muscles piriformis and obturator internus.…”

“…• The anterior quadrant surgical procedures included posterior vaginal wall excision, prostatic shave, bladder peritonectomy, partial cystectomy and seminal vesicle excision. 12 • The posterior quadrant surgical procedures included excision of presacral fascia.…”