Department of Surgical and Biomedical Sciences, Urology Clinic Perugia-Terni, University of Perugia, Perugia, Italy.
Department of Surgical Specialties, SC General Surgery and Surgical Specialties, St Maria Hospital, Terni, Italy.
World J Surg Oncol. 2020 May 4;18(1):86. doi: 10.1186/s12957-020-01864-1.
The incidence of synchronous RCC and colorectal cancer is heterogeneous ranging from 0.03 to 4.85%. Instead, only one case of huge colon carcinoma and renal angiomyolipoma was reported. The treatment of synchronous kidney and colorectal neoplasm is, preferably, synchronous resection. Currently, laparoscopic approach has shown to be feasible and safe, and it has become the gold standard of synchronous resection due to advantages of minimally invasive surgery. We presented a case synchronous renal neoplasm and colorectal cancer undergone simultaneous totally robotic renal enucleation and rectal resection with primary intracorporeal anastomosis. As our knowledge, this is the first case in literature of simultaneous robotic surgery for renal and colorectal tumor.
A 53-year-old woman was affected by recto-sigmoid junction cancer and a solid 5 cm left renal mass. We performed a simultaneous robotic low anterior rectal resection and renal enucleation. Total operative time was 260 min with robotic time of 220 min; estimated blood loss was 150 ml; time to flatus was 72 h, and oral diet was administered 4 days after surgery. The patient was discharged on the eighth post-operative day without peri- and post-operative complication. The definitive histological examination showed a neuroendocrine tumor pT2N1 G2, with negative circumferential and distal resection margins. Renal tumor was angiomyolipoma. At 23 months follow-up, the patient is recurrence free.
As our knowledge, we described the first case in literature of simultaneous robotic anterior rectal resection and partial nephrectomy for treatment of colorectal tumor and renal mass. Robotic rectal resection with intracorporeal anastomosis surgery seems to be feasible and safe even when it is associated with simultaneous partial nephrectomy. Many features of robotic technology could be useful in combined surgery. This strategy is recommended only when patients' medical conditions allow for longer anesthesia exposure. The advantages are to avoid a delay treatment of second tumor, to reduce the time to start the post-operative adjuvant chemotherapy, to avoid a second anesthetic procedure, and to reduce the patient discomfort. However, further studies are needed to evaluate robotic approach as standard surgical strategy for simultaneous treatment of colorectal and renal neoplasm.
同时发生的肾细胞癌和结直肠癌的发病率差异很大，范围从 0.03 到 4.85%。相反，仅报道了一例巨大结肠腺癌和肾血管平滑肌脂肪瘤的病例。同时发生的肾和结直肠肿瘤的治疗方法，最好是同时切除。目前，腹腔镜方法已被证明是可行和安全的，并且由于微创手术的优势，它已成为同时切除的金标准。我们报告了一例同时发生的肾肿瘤和结直肠癌患者，接受了同期全机器人肾部分切除术和直肠切除术，并进行了原发性腔内吻合。据我们所知，这是文献中首例同时进行机器人肾和结直肠肿瘤手术的病例。
一名 53 岁女性患有直肠乙状结肠交界处癌和左肾 5cm 实性肿块。我们进行了同期机器人低位前侧直肠切除术和肾部分切除术。总手术时间为 260 分钟，机器人时间为 220 分钟；估计出血量为 150ml；肛门排气时间为 72 小时，术后第 4 天开始口服饮食。患者无围手术期并发症，术后第 8 天出院。最终组织学检查显示神经内分泌肿瘤 pT2N1 G2，环周和远端切缘阴性。肾肿瘤为血管平滑肌脂肪瘤。在 23 个月的随访中，患者无复发。
据我们所知，我们描述了文献中首例同时进行机器人直肠前切除术和部分肾切除术治疗结直肠肿瘤和肾肿块的病例。即使同时进行部分肾切除术，机器人直肠切除术联合腔内吻合术似乎也是可行和安全的。机器人技术的许多特点在联合手术中可能很有用。只有当患者的身体状况允许更长时间的麻醉暴露时，才推荐这种策略。这种策略的优点是避免延迟治疗第二个肿瘤，减少开始术后辅助化疗的时间，避免第二次麻醉程序，并减少患者不适。然而，需要进一步的研究来评估机器人方法作为同时治疗结直肠和肾肿瘤的标准手术策略。
