title: Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation.
abstract: Laparoscopic multi-visceral resection in patients with T4 colorectal cancer remains controversial. A 73-year-old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long-term follow-up are required to resolve oncological outcomes.
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Hidenobu
authors: H
authors: Ishizaki
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Shinya
authors: S
authors: Nakashima
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Takeomi
authors: T
authors: Hamada
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Takahiro
authors: T
authors: Nishida
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Naoki
authors: N
authors: Maehara
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Takuto
authors: T
authors: Ikeda
authors: Department of Urology, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Hiromasa
authors: H
authors: Tsukino
authors: Department of Urology, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Shoichiro
authors: S
authors: Mukai
authors: Department of Urology, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Toshiyuki
authors: T
authors: Kamoto
authors: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
authors: Kazuhiro
authors: K
authors: Kondo
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009361:Neoplasm Invasiveness; D010385:Pelvic Exenteration / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Advanced rectal cancer; anterior pelvic exenteration; laparoscopic multi-visceral resection