title: Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer.
abstract: Total pelvic exenteration (TPE) may be the only procedure that can cure T4 rectal cancer that directly invades the urinary bladder or prostate. Here, we describe our experience of laparoscopic TPE with en bloc lateral lymph node dissection for advanced primary rectal cancer. A 62-year-old man diagnosed with advanced lower rectal cancer (T4bN0M0) underwent laparoscopic TPE with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy. Ligation of the dorsal vein complex was performed under direct visualization through the perineal approach, and the large perineal defect was reconstructed using bilateral V-Y advancement of the gluteus maximus musculocutaneous flaps. The ileal conduit was constructed extracorporeally through an extended umbilical port that was extended to 4 cm. The total operative time was 831 min and estimated blood loss was 600 mL. Laparoscopic TPE appears to be safe and feasible in selected patients.
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Mukai
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyoshi
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueno
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ikeda
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000379:methods*; D010386:Pelvic Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: Laparoscopic surgery; rectal cancer; total pelvic exenteration