Laparoscopy-assisted Exenteration of the Pelvis in a Locally Advanced Rectal Carcinoma

Overview

Introduction:
In this pilot study, based on three case-reviews, the authors report on their initial experience with the laparoscopy- assisted total exenteration of the pelvis, conducted in patients with locally advanced rectal carcinomas.

Methods:
In two patients with histologically confirmed rectal carcinomas, the neoadjuvant radiochemotherapy was initiated, due to the locally advanced tumor finding, aiming to downstage and locally control the disorder. The pelvic exenteration was indicated, based on the control findings of the imagining methods. In one patient, due to repetitive enterorrhagies, the primary surgical management was indicated.

Results:
The surgical procedures were multidisciplinary, assisted by urologists. In all three cases, the laparoscopic resections, followed by planned conversions and constructions of the ileouretheral conduit and the terminal sigmoidostomies (resp. with their maintenance), were completed. Prior to the procedures, in all the three patients, the presence of distant metastases was excluded. No peroperative complications were recorded in the case-reviews. In one case, postoperative re-suturing of the wound was inevitable, due to its dehiscence. In this patient, the enzymatic acute MI, without the ECG correlate, was diagnosed.

Conclusion:
The laparoscopy-assisted pelvic exenteration may be a suitable modification of the classical surgical procedure in selected patient groups with locally advanced colorectal carcinomas. Good visualisation and exact orientation in the region of the small pelvis, as well as other generally accepted advantages of miniinvasive procedures, are the pros of the method.

Key words:
rectal carcioma – total pelvic exenteration – laparoscopy