Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Abstract

Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.

Keywords

Minimal invasive surgery / laparoscopic surgery / robotic surgery / beyond total mesorectal excision / extended resection / locally advanced rectal cancer / pelvic exenteration / lateral pelvic lymph node dissection

References

[1] Bhangu A,Brown G,Tekkis P.Indications and outcome of pelvic exenteration for locally advanced primary and recurrent rectal cancer.Ann Surg2014;259:315-22

[2] Georgiou PA,Brown G.Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options.Cancer Imaging2011;11:S103-11 PMCID:PMC3266566

[3] Georgiou PA,Constantinides VA,Goldin RD,John Nicholls R.Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer.Eur J Cancer2013;49:72-81

[4] Georgiou P,Constantinides V,Nicholls R.Diagnostic accuracy of MRI in assessing tumor invasion within pelvic compartments in recurrent and locally advanced rectal cancer.Dis Colon Rectum2009;52:9

[5] Denost Q,Rasheed S,Brasio R,Rullier E.Individualizing surgical treatment based on tumour response following neoadjuvant therapy in T4 primary rectal cancer.Eur J Surg Oncol2017;43:92-9

[6] Smith JD,Weiser MR,Guillem JG.Multivisceral resections for rectal cancer.Br J Surg2012;99:1137-43

[7] Beyond TME Collaborative.Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes..Br J Surg2013;100:1009-14

[8] Kim MJ,Kim TH,Kim SY,Chang HJ,Oh JH.Is lateral pelvic node dissection necessary after preoperative chemoradiotherapy for rectal cancer patients with initially suspected lateral pelvic node?.Surgery2016;160:366-76

[9] Kim MJ,Kim DY,Baek JY,Park SC,Oh JH.Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer?.J Surg Oncol2015;111:459-64

[10] Yang TX,Chua TC.Pelvic exenteration for rectal cancer: a systematic review.Dis Colon Rectum2013;56:519-31

[11] Guillou PJ,Thorpe H,Jayne DG,Heath RM.Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.Lancet2005;365:1718-26

[12] Jeong SY,Nam BH,Kang SB,Choi HS,Chang HJ,Jung KH,Kang GH,Kim SY,Kim DH,Lee HS,Oh JH.Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial.Lancet Oncol2014;15:767-74

[13] van der Pas MH,Cuesta MA,Lacy AM,Bonjer HJ.Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial.Lancet Oncol2013;14:210-8

[14] Rodríguez-Sanjuán JC,Trugeda-Carrera S,López-Useros A.Laparoscopic and robot-assisted laparoscopic digestive surgery: present and future directions.World J Gastroenterol2016;22:1975-2004 PMCID:PMC4726673

[15] Park S.The role of robotic surgery for rectal cancer: overcoming technical challenges in laparoscopic surgery by advanced techniques.J Korean Med Sci2015;30:837-46 PMCID:PMC4479934

[16] Lanfranco AR,Desai JP.Robotic surgery: a current perspective.Ann Surg2004;239:14-21 PMCID:PMC1356187

[17] Park EJ,Baek SJ,Min BS,Lee KY.Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery.Ann Surg2015;261:129-37

[18] Saklani AP,Hur H,Baik SH,Kim NK.Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes.Int J Colorectal Dis2013;28:1689-98

[19] Xiong B,Zhang C.Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis.J Surg Res2014;188:404-14

[20] Jayne D,Marshall H,Corrigan N,Quirke P,Rautio T,Tilney H,Bianchi PP,Hulme C.Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial.JAMA2017;318:1569-80 PMCID:PMC5818805

[21] Bretagnol F,Zappa M,Ferron M.T4 colorectal cancer: is laparoscopic resection contraindicated?.Colorectal Dis2011;13:138-43

[22] de'Angelis N,Vitali GC,Martínez-Pérez A,Assalino M,Mercoli HA,Mutter D,Espin E.Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer.Surg Endosc2017;31:3106-21

[23] Park SY,Jun SH,Kim HJ.Laparoscopic salvage surgery for recurrent and metachronous colorectal cancer: 15 years' experience in a single center.Surg Endosc2011;25:3551-8

[24] Nagasue Y,Ueno M,Nagayama S,Konishi T,Nagata J,Ikeda A,Yamaguchi T.Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes.J Gastrointest Surg2013;17:1299-305

[25] Nagasaki T,Ueno M,Nagayama S,Konishi T.Laparoscopic salvage surgery for locally recurrent rectal cancer.J Gastrointest Surg2014;18:1319-26

[26] Kim KY,Park YK.A single surgeon's experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely?.Surg Endosc2012;26:493-500

[27] Sasson AR.Management of locally advanced rectal cancer.Surg Oncol2000;9:193-204

[28] Mukai T,Ueno M,Nagayama S,Konishi T,Yamaguchi T.Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer.Asian J Endosc Surg2013;6:314-7

[29] Uehara K,Yoshino Y,Kato T,Ebata T.Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery.Surg Endosc2016;30:132-8

[30] Patel H,Amodeo A.Laparoscopic salvage total pelvic exenteration: is it possible post-chemo-radiotherapy?.J Minim Access Surg2009;5:111-4 PMCID:PMC2843126

[31] Akiyoshi T,Ueno M.Laparoscopic total pelvic exenteration for locally recurrent rectal cancer.Ann Surg Oncol2015;22:3896

[32] Ogura A,Konishi T,Nagayama S,Ueno M.Safety of laparoscopic pelvic exenteration with urinary diversion for colorectal malignancies.World J Surg2016;40:1236-43

[33] Patil PS,Gambhire P,Engineer R,Chopra S.Colorectal cancer in India: an audit from a tertiary center in a low prevalence area.Indian J Surg Oncol2017;8:484-90

[34] Pai VD,Ostwal V,Arya S,Bal M.Multivisceral resections for rectal cancers: short-term oncological and clinical outcomes from a tertiary-care center in India.J Gastrointest Oncol2016;7:345-53 PMCID:PMC4880780

[35] Sinukumar S,Saklani A.Preliminary experience with lateral pelvic lymph node dissection in locally advanced rectal cancer.Indian J Gastroenterol2015;34:320-4

[36] Pai VD,Saklani AP.Laparoscopic total mesorectal excision with enbloc resection of seminal vesicle for locally advanced rectal adenocarcinoma.J Laparoendosc Adv Surg Tech A2016;26:209-12

[37] Bhamre R,Shinde R.Laparoscopic total pelvic exenteration for locally advanced carcinoma of the rectum - a video vignette.Colorectal Dis2018;20:161-2

[38] Pokharkar A,D'souza A,Sugoor P.Laparoscopic pelvic exenteration for locally advanced rectal cancer, technique and short-term outcomes..J Laparoendosc Adv Surg Tech A2018;

[39] Hayashi K,Kakiuchi D,Hada M,Hiranuma C,Hara T.Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer.Surg Case Rep2016;2:74 PMCID:PMC4961659

[40] Uematsu D,Sugihara T,Yamaguchi T.Transanal total pelvic exenteration: pushing the limits of transanal total mesorectal excision with transanal pelvic exenteration.Dis Colon Rectum2017;60:647-8

[41] Vasilescu C,Popa M,Gluck G.Entirely robotic total pelvic exenteration.Surg Laparosc Endosc Percutan Tech2011;21:e200-2

[42] Castillo OA,Rodriguez-Carlin A,Schatloff O.First report: robot-assisted total pelvic exenteration for locally advanced prostate cancer.J Laparoendosc Adv Surg Tech A2015;25:592-4

[43] Nanayakkara PR,Oudit D,Selvasekar CR.Robotic assisted minimally invasive pelvic exenteration in advanced rectal cancer: review and case report.J Robot Surg2014;8:173-5

[44] Shin JW,Kwak JM,Cheon J,Kang SG,Coughlin G.First report: robotic pelvic exenteration for locally advanced rectal cancer.Colorectal Dis2014;16:O9-14

[45] Winters BR,Louie O.Robotic total pelvic exenteration with laparoscopic rectus flap: initial experience.Case Rep Surg2015;2015:835425

[46] Malakorn S,Pisters LL.Robotic total pelvic exenteration.Dis Colon Rectum2017;60:555

[47] Kim TH,Choi DH,Jung KH,Chang HJ,Choi HS.Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection.Ann Surg Oncol2008;15:729-37

[48] Yano H.The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West.Br J Surg2008;95:33-49

[49] Akiyoshi T,Miyata S,Muto T.Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease?.Ann Surg2012;255:1129-34

[50] Watanabe T,Shimada Y,Ito Y,Hamaguchi T,Igarashi M,Ishihara S,Kanemitsu Y,Muro K,Oguchi M,Saito Y,Ueno H,Boku N,Koinuma N,Nishimura G,Takahashi K.Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer.Int J Clin Oncol2015;20:207-39 PMCID:PMC4653248

[51] Moran B.Exploring the limits in low rectal cancer.Lancet Oncol2012;13:565-7

[52] Akiyoshi T,Matsueda K,Fujimoto Y,Fukunaga Y,Kano A,Oya M,Watanabe T.Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging.Ann Surg Oncol2014;21:189-96

[53] Nagawa H,Sunouchi K,Tsurita G,Sawada T.Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy..Dis Colon Rectum2001;44:1274-80

[54] Fujita S,Mizusawa J,Kinugasa Y,Ohue M,Shiozawa M,Moriya Y.Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial..Lancet Oncol2012;13:616-21

[55] Gk K,Ap S.Is there a role of lateral pelvic lymph node dissection in the current era of neoadjuvant chemoradiotherapy for rectal cancer?.J Gastrointest Digest Syst2016;6:1-4

[56] Mahendra BK,Saklani A.Lateral pelvic lymph node dissection - are we ready to bridge the gap between the west and the east?.Ann Laparosc Endosc Surg2017;2:158

[57] Sasi S,Kammar P,Desouza A.Robotic lateral pelvic lymph node dissection (LPLND) in rectal cancer - video vignette.Colorectal Dis2018;20:554-5

[58] Liang JT.Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy.Ann Surg Oncol2011;18:153-9

[59] Park JS,Lim KH,Kim HJ,Jun SH.Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience.Surg Endosc2011;25:3322-9

[60] Liu T,Yu P,Zeng D,Lv W,Yan X.Laparoscopic radical correction combined with extensive lymphadenectomy and pelvic autonomic nerve preservation for mid-to-low rectal cancer.Clin Colorectal Cancer2011;10:183-7

[61] Akiyoshi T.Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer.World J Gastroenterol2016;22:718-26 PMCID:PMC4716071

[62] Nagayoshi K,Manabe T,Yanai K,Tanaka M.Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach.Surg Endosc2016;30:1938-47

[63] Wichmann MW,Meyer G,Hornung HM,Angele MK.Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer.Arch Surg2002;137:206-10

[64] Kim YW,Min BS,Sohn SK,Kim H,Ahn JB.The prognostic impact of the number of lymph nodes retrieved after neoadjuvant chemoradiotherapy with mesorectal excision for rectal cancer.J Surg Oncol2009;100:1-7

[65] Furuhata T,Nishidate T,Yamaguchi H,Akizuki E,Ogawa T,Kimura Y,Hirata K.Clinical feasibility of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision for advanced rectal cancer.Surg Today2015;45:310-4

[66] Park JA,Park JS.Initial clinical experience with robotic lateral pelvic lymph node dissection for advanced rectal cancer.J Korean Soc Coloproctol2012;28:265-70 PMCID:PMC3499428

[67] Bae SU,Hur H,Baik SH,Kim NK.Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series.Ann Surg Treat Res2014;86:76-82 PMCID:PMC3994600

[68] Kagawa H,Shiomi A,Tsukamoto S,Yamakawa Y.Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients.Surg Endosc2015;29:995-1000

[69] Yamaguchi T,Shiomi A,Kagawa H.Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer.Surg Endosc2016;30:721-8

[70] Kim HJ,Park JS,Lee HJ,Park IK.Selective lateral pelvic lymph node dissection: a comparative study of the robotic versus laparoscopic approach.Surg Endosc2018;32:2466-73

[71] Wiig JN,Larsen SG,Giercksky KE.Radical prostatectomy for locally advanced primary or recurrent rectal cancer.Eur J Surg Oncol2003;29:455-8

[72] Saito N,Sugito M,Kobayashi A,Kotaka M,Kobatake T,Shiomi A,Minagawa N.Bladder-sparing extended resection of locally advanced rectal cancer involving the prostate and seminal vesicles.Surg Today2007;37:845-52

[73] Smith JD,Weiser MR,Guillem JG.Multivisceral resections for rectal cancer.Br J Surg2012;99:1137-43

[74] Shin US,Nguyen AT,Messick C,Dean EM,Hu CY.Oncologic outcomes of extended robotic resection for rectal cancer.Ann Surg Oncol2016;23:2249-57

[75] Williams GL,Bandyopadhyay D.Laparoscopic abdominosacral composite resection for locally advanced primary rectal cancer.Tech Coloproctol2008;12:299-302

[76] Nagasaki T,Ueno M,Nagayama S,Konishi T.Laparoscopic abdominosacral resection for locally advanced primary rectal cancer after treatment with mFOLFOX6 plus bevacizumab, followed by preoperative chemoradiotherapy.Asian J Endosc Surg2014;7:52-5

[77] Lengyel J,Morrison C,Lee P.Multimedia article Laparoscopic abdominosacral composite resection..Dis Colon Rectum2009;52:1662-4

[78] Uemura M,Kawai K,Takemasa I,Yamamoto H,Doki Y.Laparoscopic surgery using a Gigli wire saw for locally recurrent rectal cancer with concomitant intraperitoneal sacrectomy.Asian J Endosc Surg2018;11:83-6