Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Ann Surg Oncol. 2024 Dec;31(13):8952-8953. doi: 10.1245/s10434-024-16149-0. Epub 2024 Sep 4.
About 70% of women affected by ovarian cancer experience relapse within 2 years of diagnosis. Traditionally, the standard treatment for recurrent ovarian cancer (ROC) has been represented by systemic chemotherapy. Recently, several retrospective studies have suggested that secondary cytoreductive surgery could provide better clinical outcomes than chemotherapy alone, in the case of complete tumor cytoreduction. About 50% of patients with ROC have a pelvic component of the disease and 22% of patients present isolated pelvic recurrence, often involving the rectum. Minimally invasive secondary cytoreductive surgery is a feasible option and is associated with favorable perioperative outcomes. It is crucial to fully explore the peritoneal cavity before starting cytoreductive procedures in order to confirm the absence of carcinomatosis. The robotic system facilitates the identification of anatomical structures and makes it easier to perform complex surgical steps in narrow spaces. It also allows the integrated use of surgical tools such as intraoperative ultrasound and indocyanine green application.
In this video, we present the case of a 64-year-old woman who experienced a rectal recurrence of ovarian cancer after a platinum-free interval of 12 months. We describe, in a step-by-step manner, the surgical procedure of a robotic rectosigmoid resection with totally intracorporeal colorectal anastomosis (TICA). RESULTS: Robotic secondary cytoreduction with complete gross resection was achieved. The patient did not report any intraoperative or postoperative complications. Final histology confirmed ROC.
Totally robotic rectosigmoid resection is a feasible option in isolated bowel recurrences. Thanks to continuous technical evolution, robot-assisted surgery has the potential to have a central role in the fight against solid tumors. Integration of multiple pre- and intraoperative technologies allows personalized surgery to be performed for each different patient..
约 70%的卵巢癌患者在诊断后 2 年内复发。传统上，复发性卵巢癌（ROC）的标准治疗方法是全身化疗。最近，几项回顾性研究表明，在完全肿瘤细胞减灭的情况下，二次细胞减灭手术可能比单独化疗提供更好的临床结果。约 50%的 ROC 患者有盆腔疾病，22%的患者出现孤立性盆腔复发，常累及直肠。微创二次细胞减灭术是一种可行的选择，与良好的围手术期结果相关。在开始细胞减灭手术之前，充分探查腹膜腔以确认无癌性腹膜转移至关重要。机器人系统有助于识别解剖结构，并使在狭窄空间中执行复杂的手术步骤变得更加容易。它还允许手术工具的集成使用，如术中超声和吲哚菁绿应用。
在这个视频中，我们介绍了一位 64 岁女性的病例，她在无铂间隔 12 个月后出现卵巢癌直肠复发。我们以逐步的方式描述了机器人直肠乙状结肠切除术和完全经内的结直肠吻合术（TICA）的手术过程。
实现了机器人辅助二次细胞减灭术和完全肉眼下肿瘤切除。患者未报告任何术中或术后并发症。最终的组织学证实为 ROC。
完全机器人直肠乙状结肠切除术是孤立性肠道复发的一种可行选择。得益于持续的技术进步，机器人辅助手术有可能在治疗实体肿瘤方面发挥核心作用。多种术前和术中技术的整合允许为每个不同的患者进行个性化手术。
