Pokharkar Ashish, Bankar Sanket, Rohila Jitender, Jaiswal Dushyant, deSouza Ashwin, Saklani Avanish
Department of Colorectal Surgery and Tata Memorial Hospital, Parel, Mumbai, India.
Department of Plastic Surgery, Tata Memorial Hospital, Parel, Mumbai, India.
J Laparoendosc Adv Surg Tech A. 2020 May;30(5):558-563. doi: 10.1089/lap.2019.0691. Epub 2019 Nov 27.
Laparoscopic posterior exenteration (total and supralevator) is a complex and rarely done procedure. In this study we describe the surgical technique and short-term perioperative outcomes in 7 female patients of locally advanced carcinoma rectum operated with laparoscopic pelvic exenteration. We report 7 cases of carcinoma rectum involving either posterior wall of the uterus or vagina, which were operated with a laparoscopic procedure. All perioperative and intraoperative data were collected retrospectively from prospectively maintained electronic data. Nine female patients with the diagnosis of nonmetastatic locally advanced lower rectal adenocarcinoma were selected. In MRI 4 patients had uterus-cervix involvement and 3 patients had a posterior vaginal wall and anal sphincter involvement. Four patients were operated with laparoscopic supralevator posterior exenteration and 3 patients were operated with laparoscopic complete posterior exenteration. Three patients underwent vaginal reconstruction, which was done with bilateral V-Y plasty. All 7 patients received neoadjuvant chemoradiotherapy (NACTRT), 3 patients also received additional chemotherapy (CAPOX regimen) due to poor response to NACTRT. Mean body mass index (BMI) was 23.85 (range 19-27.20). Mean duration for complete posterior exenteration was 9.63 hours (range 7-12 hours). Mean duration for supralevator posterior exenteration was 6.81 hours (range 6.25-7.5 hours). The mean postoperative stay was 10.71 days (range 7-16 days). Mean blood loss was 700 mL (range 200-1800 mL). On postoperative histopathology, all margins were free of tumor in all cases. Laparoscopic approach for locally advanced carcinoma rectum in female patients is feasible with less morbidity and safe short-term oncological outcomes. Careful selection of patients based on MRI is a must before undertaking the minimally invasive surgery approach. Long-term outcomes are still unknown and will require long-term follow-up.
腹腔镜后盆腔脏器清除术（全盆腔和提肛肌上清除术）是一种复杂且很少实施的手术。在本研究中，我们描述了7例接受腹腔镜盆腔脏器清除术的局部晚期直肠癌女性患者的手术技术和短期围手术期结果。我们报告了7例累及子宫后壁或阴道的直肠癌病例，均采用腹腔镜手术治疗。所有围手术期和术中数据均从前瞻性维护的电子数据中回顾性收集。选择了9例诊断为非转移性局部晚期低位直肠腺癌的女性患者。在磁共振成像（MRI）检查中，4例患者子宫颈受累，3例患者阴道后壁和肛门括约肌受累。4例患者接受了腹腔镜提肛肌上后盆腔脏器清除术，3例患者接受了腹腔镜完全后盆腔脏器清除术。3例患者接受了双侧V-Y成形术进行阴道重建。所有7例患者均接受了新辅助放化疗（NACTRT），3例患者因对NACTRT反应不佳还接受了额外化疗（CAPOX方案）。平均体重指数（BMI）为23.85（范围19 - 27.20）。完全后盆腔脏器清除术的平均时长为9.63小时（范围7 - 12小时）。提肛肌上后盆腔脏器清除术的平均时长为6.81小时（范围6.25 - 7.5小时）。术后平均住院时间为10.71天（范围7 - 16天）。平均失血量为700毫升（范围200 - 1800毫升）。术后组织病理学检查显示，所有病例的切缘均无肿瘤。对于女性局部晚期直肠癌患者，腹腔镜手术方法可行，发病率较低且短期肿瘤学结果安全。在采用微创手术方法之前，必须根据MRI仔细选择患者。长期结果仍未知，需要长期随访。
