Ann Surg Treat Res.  2021 Aug;101(2):102-110. 10.4174/astr.2021.101.2.102.

Combined transabdominal and transperineal endoscopic pelvic exenteration for colorectal cancer: feasibility and safety of a two-team approach

• Tominaga T
• Nonaka T
• Fukuda A
• Shiraisi T
• Hashimoto S
• Araki M
• Sumida Y
• Sawai T
• Nagayasu T

• KMID: 2519003
• DOI: http://doi.org/10.4174/astr.2021.101.2.102

Abstract

Purpose
Pelvic exenteration (PE) is a highly invasive procedure with high morbidity and mortality rates. Promising options to reduce this invasiveness have included laparoscopic and transperineal approaches. The aim of this study was to identify the safety of combined transabdominal and transperineal endoscopic PE for colorectal malignancies.
Methods
Fourteen patients who underwent combined transabdominal and transperineal PE (T group: 2-team approach, n = 7; O group: 1-team approach, n = 7) for colorectal malignancies between April 2016 and March 2020 in our institutions were included in this study. Clinicopathological features and perioperative outcomes were compared between groups.
Results
All patients successfully underwent R0 resection. Operation time tended to be shorter in the T group (463 minutes) than in the O group (636 minutes, P = 0.080). Time to specimen removal was significantly shorter (258 minutes vs. 423 minutes, P = 0.006), blood loss was lower (343 mL vs. 867 mL, P = 0.042), and volume of blood transfusion was less (0 mL vs. 560 mL, P = 0.063) in the T group, respectively. Postoperative complications were similar between groups.
Conclusion
Combined transabdominal and transperineal PE under a synchronous 2-team approach was feasible and safe, with the potential to reduce operation time, blood loss, and surgeon stress.

Keyword

Laparoscopic surgery; Pelvic exenteration; Transabdominal; Transperineal; Two-team approach

Figure

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  Fig. 1 Transperineal view before dissecting the urethra and dorsal vein complex (DVC). Written informed consent was obtained for this image.

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  Fig. 2 Transperineal view after total pelvic exenteration with lateral lymph node dissection. Written informed consent was obtained for this image. EIA, external iliac artery; EIV, external iliac vein; IIA, internal iliac artery; IIV, internal iliac vein.

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  Fig. 3 Schematic diagrams of the pelvic exenteration procedure presented in this study. Arrowheads, transabdominal approach; arrows, transperineal approach.

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