Abstract
Background:
Total pelvic exenteration (TPE) is the required procedure for locally advanced rectal cancer with prostate invasion. Bladder-sparing extended resection of locally advanced rectal cancer to avoid TPE has been reported as feasible. 1,2 Here, we undertook recto-prostatectomy by laparoscopic surgery. To the best of our knowledge, this is the first report of this laparoscopic procedure for locally advanced rectal cancer.
Methods:
A 50-year-old man was having locally advanced rectal cancer with prostate invasion. The patient was having clinical stage IIIC disease. Neoadjuvant chemotherapy (NAC) without radiotherapy was initiated. After NAC, the tumor shrank from 48 to 35 mm maximum diameter. However, invasion of the prostate was still present. There were swollen lymph nodes in the mesorectum and along the left internal iliac artery. We undertook recto-prostatectomy with combined resection of the left lateral lymph node, left internal iliac vessels, and part of the autonomic nervous system. For functional preservation, the right side of the pelvic plexus and neurovascular bundle were preserved. A rectocolonic anastomosis and cystourethral anastomosis were carried out.
Results:
The total operative time was 841 min, with an estimated blood loss of 1114 mL. Final pathology report showed negative resection margins. Postoperative urinary function was excellent.
Conclusions:
Laparoscopic bladder-sparing recto-prostatectomy for locally advanced rectal cancer can preserve satisfactory urinary function while remaining curative for selected patients.
No competing financial interests exist.
Runtime of video: 8 mins
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