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Stepwise Approach for Robotic Total Pelvic Exenteration with En Bloc Presacral Fascia in T4b Rectal Cancer
Kitrawee Jirathaniruangkit1, Gantapong Sainont2, Songphol Malakorn3
1Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Annals of Surgical Oncology
|March 11, 2025
Summary
Robotic total pelvic exenteration (TPE) is safe for T4b rectal cancer, achieving negative margins and no complications. This minimally invasive approach expands surgical options for complex rectal cancer cases.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Rectal Cancer Treatment
Background:
- T4 rectal cancers often require extensive resection beyond standard total mesorectal excision (TME).
- Minimally invasive surgery, including robotic approaches, is increasingly recognized as feasible and safe for select T4 rectal cancers.
- This study focuses on a robotic total pelvic exenteration (TPE) with en bloc presacral fascia resection for T4b rectal cancer.
Purpose of the Study:
- To demonstrate a stepwise robotic surgical approach for T4b rectal cancer.
- To highlight the management of internal iliac vessel branches and presacral fascia during robotic TPE.
- To confirm the safety and feasibility of minimally invasive surgery in complex rectal cancer cases.
Main Methods:
- A patient with locally advanced mid-rectal cancer underwent robotic TPE with en bloc presacral fascia resection after neoadjuvant therapy.
- The procedure involved meticulous dissection of pelvic structures, including management of the inferior mesenteric vessels, presacral fascia, and internal iliac artery branches.
- Key steps included extravascular dissection, securing the obturator nerve, and controlled division of vascular and urinary structures before specimen removal.
Main Results:
- Pathology confirmed ypT4bN1a with all surgical margins negative (R0 resection).
- The patient experienced an uncomplicated recovery and was discharged on postoperative Day 5.
- Postoperative imaging at 6 months showed no evidence of local recurrence or distant metastasis.
Conclusions:
- Robotic TPE with en bloc presacral fascia resection is a safe and feasible option for selected T4b rectal cancer patients.
- This minimally invasive technique expands the application of robotic surgery for complex oncological resections.
- Successful outcomes in this case support the continued exploration of advanced robotic procedures for challenging rectal cancers.
