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Harji D, Chauvet A, Pouplin J, Robert G, Denost Q. Robotic total pelvic exenteration with coloanal anastomosis and enterocystoplasty - a video vignette. Colorectal Dis 2021; 23:3049. [PMID: 34390106 DOI: 10.1111/codi.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/09/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Deena Harji
- Département de chirurgie Colorectal, Hôpital Haut-Lévèque, Pessac, France
| | - Alexandre Chauvet
- Département de chirurgie Colorectal, Hôpital Haut-Lévèque, Pessac, France
| | - Julien Pouplin
- Département de chirurgie Colorectal, Hôpital Haut-Lévèque, Pessac, France
| | | | - Quentin Denost
- Département de chirurgie Colorectal, Hôpital Haut-Lévèque, Pessac, France
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Kazi M, Kumar NAN, Rohila J, Sukumar V, Engineer R, Ankathi S, Desouza A, Saklani A. Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes. BJS Open 2021; 5:6369779. [PMID: 34518872 PMCID: PMC8438253 DOI: 10.1093/bjsopen/zrab074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/13/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study compared the surgical and oncological outcomes of open and minimally invasive pelvic exenteration. METHODS Patients who underwent pelvic exenterations for primary locally advanced rectal cancers with invasion of the urogenital organs (central and anterior disease) between August 2013 and September 2020 were reviewed retrospectively. Patients were categorized as undergoing open or minimally invasive surgery (MIS) and these groups were compared for perioperative outcomes and 3-year survival (overall, recurrence-free and local relapse-free survival). Multivariable Cox regression analysis was performed to assess the independent influence of approach of surgery and cancer features on recurrence-free survival (RFS). RESULTS Of the 158 patients who underwent pelvic exenteration, 97 (61.4 per cent) had open exenterations and 61 (38.6 per cent) patients had an MIS resection (44 patients (72 per cent) using laparoscopy and 17 (28 per cent) using robotic surgery). There were 96 (60.8 per cent) total pelvic exenterations and 62 (39.2 per cent) posterior pelvic exenterations. MIS exenterations had significantly longer operative times (MIS versus open: 640 mins versus 450 mins; P < 0.001) but reduced blood loss (MIS versus open: 900 ml versus 1600 ml; P < 0.001) and abdominal wound infections (MIS versus open: 8.2 versus 17.5 per cent; P = 0.020) without a difference in hospital stay (MIS versus open: 11 versus 12 days; P = 0.620). R0 resection rates and involvement of circumferential resection margins were similar (MIS versus open: 88.5 versus 91.8 per cent, P = 0.490 and 13.1 versus 8.2 per cent, P = 0.342 respectively). At a median follow-up of 29 months, there were no differences in 3-year overall survival (MIS versus open: 79.4 versus 60.2 per cent; P = 0.251), RFS (MIS versus open: 51.9 versus 47.8 per cent; P = 0.922) or local relapse-free survival (MIS versus open: 89.7 versus 75.2 per cent; P = 0.491. On multivariable analysis, approach to surgery had no bearing on RFS, and only known distant metastasis, aggressive histology and inadequate response to neoadjuvant radiation (pathological tumour regression grade greater than 3) predicted worse RFS. CONCLUSION MIS exenterations documented longer procedures but resulted in less blood loss and fewer wound infections compared with open surgeries. In the setting of an experienced centre, the hospital stay, R0 resection rates and oncological outcomes at 3 years were similar to those of open exenterations.
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Affiliation(s)
- M Kazi
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - N A N Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - J Rohila
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - V Sukumar
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - R Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - S Ankathi
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Desouza
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Kumar NA, Sasi SP, Shinde RS, Verma K, Sugoor P, Desouza A, Engineer R, Saklani A. Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer. JSLS 2021; 24:JSLS.2020.00026. [PMID: 32714002 PMCID: PMC7347395 DOI: 10.4293/jsls.2020.00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Minimally invasive surgery (MIS) for pelvic exenteration is not a well-established technique. The aim was to assess the safety and feasibility of MIS for pelvic exenteration in locally advanced primary colorectal cancer and to compare the perioperative outcomes with open surgery. Methods: This is a retrospective analysis of patients, who had undergone pelvic exenteration for primary colorectal adenocarcinoma from May 2013 to July 2018. The short-term outcomes like perioperative details and histopathological characteristics were compared between the two groups. Results: MIS was performed in 23 patients and open pelvic exenteration was carried out in 72 patients. The mean operative time was significantly more in the MIS group (640 vs. 432 min, p = 0.00). The intraoperative blood loss (900 vs. 1550 ml, p = 0.00) and the requirement for blood transfusion (170 vs. 250 ml, p = 0.03) was significantly less in the MIS group. The overall morbidity (60% vs. 49%, p = 0.306) was comparable between the two groups. The median length of hospital stay in the MIS group was 11 d, compared to 12 d in the open surgery group, (p = 0.634). The rate of R0 resection (87% vs. 89%, p = 0.668) was comparable between the two groups. Conclusion: MIS is feasible and safe for total pelvic exenteration and posterior exenteration in carefully selected locally advanced primary colorectal cancer, when performed by an experienced surgical team in high volume centers. An R0 resection with adequate margin can be achieved with good perioperative outcomes in MIS. Long-term oncological outcomes would require further follow up to confirm.
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Affiliation(s)
- Naveena An Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education
| | - Sajith P Sasi
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajesh S Shinde
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kamlesh Verma
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pavan Sugoor
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwin Desouza
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Reena Engineer
- Department Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Avanish Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Raj Kumar B, Bankar S, Pandey D, Rohila J, Prakash G, Bakshi G, deSouza A, Saklani A. Abdominoperineal excision with prostatectomy in T4 rectal cancer - bladder-sparing robotic pelvic exenteration - a video vignette. Colorectal Dis 2020; 22:1786-1787. [PMID: 32548955 DOI: 10.1111/codi.15200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Affiliation(s)
- B Raj Kumar
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bankar
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - D Pandey
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Rohila
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Prakash
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Bakshi
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A deSouza
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Saklani
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Evolution of Robotic Surgery in a Colorectal Cancer Unit in India. Indian J Surg Oncol 2020; 11:633-641. [PMID: 33281404 DOI: 10.1007/s13193-020-01105-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/13/2020] [Indexed: 01/08/2023] Open
Abstract
Only a handful of institutions in the country have an established robotic surgery program. Evolution of robotic surgery in the colorectal division, from inception to recent times, is presented here. All the patients undergoing robotic colorectal surgery from the inception of the program (September 2014) to August 2019 were identified. The patient and treatment details and short-term outcomes were collected retrospectively from the prospectively maintained database. The cohort was divided into four chronological groups (group 1 being the oldest) to assess the surgical trends. There were 202 patients. Seventy-one percent were male. Mean BMI was 23.25. Low rectal tumours were most common (47%). A total of 74.3% patients received neo-adjuvant treatment. Multivisceral resection was done in 22 patients, including 4 synchronous liver resections. Average operating time for standard rectal surgery was 280 min with average blood loss of 235 ml. The mean nodal yield was 14. Circumferential resection margin positivity was 6.4%. The mean hospital stay for pelvic exenteration was significantly higher than the rest of the surgeries (except for posterior exenteration and total proctocolectomy) (p = 0.00). Clavin-Dindo grade 3 and 4 complications were seen in 10% patients. As the experience of the team increased, more complex cases were performed. Blood loss, margin positivity, nodal yield, leak rates and complications were evaluated group wise (excluding those with additional procedures) to assess the impact of experience. We did not find any significant change in the parameters studied. With increasing experience, the complexity of surgical procedures performed on da Vinci Xi platform can be increased in a systematic manner. Our short-term outcomes, i.e. nodes harvested, margin positivity, hospital stay and morbidity, are on par with world standards. However, we did not find any significant improvement in these parameters with increasing experience.
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Kumar S, Rohila J, Sasi SP, Tantravahi U, K G D, Sharma V, Garach N, deSouza A, Saklani A. Robotic-assisted low anterior resection: beyond total mesorectal excision; a left vascular approach with presacral fascia excision - a video vignette. Colorectal Dis 2020; 22:595-596. [PMID: 31901001 DOI: 10.1111/codi.14947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S Kumar
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - J Rohila
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - S P Sasi
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - U Tantravahi
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Dharmakumar K G
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - V Sharma
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - N Garach
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - A deSouza
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - A Saklani
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
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Kammar P, Sasi S, Kumar N, Rohila J, deSouza A, Saklani A. Robotic posterior pelvic exenteration for locally advanced rectal cancer - a video vignette. Colorectal Dis 2019; 21:606. [PMID: 30856286 DOI: 10.1111/codi.14606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Kammar
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - S Sasi
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - N Kumar
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - J Rohila
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - A deSouza
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - A Saklani
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
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