Top

Published in:

01-01-2016

Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery

Authors: Keisuke Uehara, Hayato Nakamura, Yasushi Yoshino, Atsuki Arimoto, Takehiro Kato, Yukihiro Yokoyama, Tomoki Ebata, Masato Nagino

Published in: Surgical Endoscopy | Issue 1/2016

Abstract

Background

Generalization of laparoscopic pelvic surgery has brought about profound knowledge of the pelvic anatomy and has encouraged expansion of indications for laparoscopic surgery to extended pelvic surgery. Pelvic exenteration (PE) is still a demanding surgical procedure and remains an essential technique for pelvic surgery although minimally invasive and function-preserving surgery is in the mainstream of surgical treatment. However, the techniques of laparoscopic PE (LPE) have been rarely explained nor has its feasibility been fully evaluated. The aim of this study was to describe important technical points and to assess the feasibility of LPE for pelvic malignancies.

Methods

Data on 67 patients with pelvic malignancies, who underwent PE between June 2006 and August 2014, were analyzed retrospectively. LPE has been indicated since 2013. Patients were divided into the LPE group (n = 9) and the conventional open PE (OPE) group (n = 58).

Results

Operative time in the LPE and OPE groups was similar (935 vs. 883 min, p = 0.398). Intraoperative blood loss in the LPE group was significantly less than that in the OPE group (830 vs. 2769 ml, p = 0.003). Pathological R0 resection rate was similar in both groups (77.8 vs. 75.9 %). Overall incidence of any complication and major complications were much lower in the LPE group (66.7 and 0 %) compared to the OPE group (89.7 and 32.8 %), although not statistically significant (p = 0.094 and 0.053, respectively). Postoperative hospital stay was significantly shorter in the LPE group than in the OPE group (27 vs. 43 days, p = 0.003).

Conclusions

We confirmed that LPE for pelvic malignancies resulted in less blood loss, a lower complication rate, and shorter postoperative hospital stay compared to OPE. LPE performed by an experienced pelvic surgeon was safe and efficient, and might be a promising option for carefully selected patients.

Rezk YA, Hurley KE, Carter J et al (2013) A prospective study of quality of life in patients undergoing pelvic exenteration: interim results. Gynecol Oncol 128:191–197PubMedPubMedCentralCrossRef

Vermaas M, Ferenschild FT, Verhoef C et al (2007) Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. Eur J Surg Oncol 33:452–458PubMedCrossRef

Chiantera V, Rossi M, De Iaco P et al (2014) Morbidity after pelvic exenteration for gynecological malignancies: a retrospective multicentric study of 230 patients. Int J Gynecol Cancer 24:156–164PubMedCrossRef

Speicher PJ, Turley RS, Sloane JL et al (2014) Pelvic exenteration for the treatment of locally advanced colorectal and bladder malignancies in the modern era. J Gastrointest Surg 18:782–788PubMedCrossRef

Jayne DG, Thorpe HC, Copeland J et al (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRef

van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218PubMedCrossRef

Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774PubMedCrossRef

Porpiglia F, Renard J, Billia M et al (2007) Open versus laparoscopy-assisted radical cystectomy: results of a prospective study. J Endourol 21:325–329PubMedCrossRef

Vizza E, Pellegrino A, Milani R et al (2011) Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy. Eur J Surg Oncol 37:364–369PubMedCrossRef

10.

Konishi T, Kuroyanagi H, Oya M et al (2011) Multimedia article. Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surg Endosc 25:2358–2359PubMedCrossRef

11.

Park JS, Choi GS, Lim KH et al (2011) Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience. Surg Endosc 25:3322–3329PubMedCrossRef

12.

Liang JT (2011) Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy. Ann Surg Oncol 18:153–159PubMedCrossRef

13.

Di Benedetto A, Soares R, Dovey Z et al (2014) Laparoscopic radical prostatectomy for high-risk prostate cancer. BJU Int (Epub ahead of print)

14.

Del Pino M, Fusté P, Pahisa J et al (2013) Laparoscopic lymphadenectomy in advanced cervical cancer: prognostic and therapeutic value. Int J Gynecol Cancer 23:1675–1683PubMedCrossRef

15.

Fernández-Martínez D, Rodríguez-Infante A, Castelo-Álvarez E et al (2014) Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer. Int J Surg Case Rep 5:584–588PubMedPubMedCentralCrossRef

16.

Martínez A, Filleron T, Vitse L et al (2011) Laparoscopic pelvic exenteration for gynaecological malignancy: Is there any advantage? Gynecol Oncol 120:374–379PubMedCrossRef

17.

Mukai T, Akiyoshi T, Ueno M et al (2013) Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer. Asian J Endosc Surg 6:314–317PubMedCrossRef

18.

Uehara K, Ito Z, Yoshino Y et al (2014) Aggressive surgical treatment with bony pelvic resectionfor locally recurrent rectal cancer. Eur J Surg Oncol (Epub ahead of print)

19.

Moriya Y, Isgiguro S (2013) Pelvic exenteration: total/anterior/posterior. In: Khatri VP (ed) Atlas of advanced operative surgery. Elsevier Publishers, Philadelphia, pp 438–446

20.

Moriya Y, Uehara K (2013) Total pelvic exenteration with distal sacrectomy for fixed locally recurrent rectal cancer. In: Khatri VP (ed) Atlas of advanced operative surgery. Elsevier Publishers, Philadelphia, pp 430–437

21.

Uehara K, Yoshioka Y, Taguchi Y et al (2012) Locally recurrent rectal cancer successfully treated by total pelvic exenteration with combined ischiopubic rami resection: report of a case. Jpn J Clin Oncol 42:58–62PubMedCrossRef

22.

Uehara K, Yamamoto S, Fujita S, Akasu T, Moriya Y (2006) Surgical outcomes of laparoscopic versus open surgery for rectal carcinoma—a matched case–control study. Hepatogastroenterology 53:531–535PubMed

23.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentralCrossRef

24.

Ferron G, Querleu D, Martel P, Letourneur B, Soulié M (2006) Laparoscopy-assisted vaginal pelvic exenteration. Gynecol Oncol 100:551–555PubMedCrossRef

25.

Veldkamp R, Kuhry E, Hop WC (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRef

26.

Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRef

27.

Yamamoto S, Inomata M, Katayama H et al (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260:23–30PubMedCrossRef

Title: Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery
Authors: Keisuke Uehara
Hayato Nakamura
Yasushi Yoshino
Atsuki Arimoto
Takehiro Kato
Yukihiro Yokoyama
Tomoki Ebata
Masato Nagino
Publication date: 01-01-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 1/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4172-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Redefining early gastric cancer

Intracorporeal ileocolic anastomosis in patients with laparoscopic right hemicolectomy

The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure

Endoscopic predictors for undifferentiated histology in differentiated gastric neoplasms prior to endoscopic resection

Nonradiation ERCP with endoscopic biliary sphincterotomy plus papillary balloon dilation for the treatment of choledocholithiasis during pregnancy

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies