Radical prostatectomy after rectal cancer surgery: surgical challenges and technical strategies - a case series

We report a case series to detail the feasibility of radical prostatectomy (RP) in patients who previously underwent rectal cancer surgery, with a specific focus on the location of the rectal anastomosis.

We reviewed the records of 11 patients who underwent RP after rectal cancer surgery. Prior rectal surgeries included low anterior resection (LAR, n = 5), high anterior resection (HAR, n = 4), intersphincteric resection (ISR, n = 1), and abdominoperineal resection (APR, n = 1). Preoperative magnetic resonance imaging was used to assess the anatomical relationship between the prostate and the colorectal anastomosis. The severity of adhesions and perioperative outcomes were assessed. Transrectal ultrasound (TRUS) and digital rectal examination (DRE) were performed intraoperatively to guide the dissection.

The median operative time and estimated blood loss were 203 min and 365 mL, respectively. Moderate-to-severe adhesions were observed in patients who underwent LAR because the anastomosis was located directly behind the prostate. Mild or no adhesions were observed in patients who underwent HAR or ISR. The patient with APR exhibited dense adhesions and descent of the small bowel into the pelvis. No rectal injuries occurred in any of the patients. Only one patient developed a Clavien-Dindo grade 3 complication.

The degree of dorsal prostate adhesions after rectal cancer surgery may vary depending on previous surgical procedures. Preoperative evaluation of surgical history and anatomy is essential, and the intraoperative use of DRE and TRUS helps ensure safe dissection. These strategies could improve the safety of patients with a history of rectal cancer surgery.