Robotic Inferior Mesenteric Artery, Common Iliac Artery, and Retroperitoneal Lymph Node Dissection

Video Type: CVideo
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Author: David Schwartzberg
Published:
Specialties: General Surgery, Obstetrics and Gynecology, Robotic Surgery
Schools: NYU Langone Medical Center, New York University Langone Medical Center
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Basic Info

David Schwartzberg MD, Tushar Samdani MD, FASCRS, Mario M. Leitao MD, FACOG, FACS, Garrett M. Nash MD, MPH, FACS, FASCRS

Recent data has shown an improved survival with metastasectomy for metastatic rectal cancer. Metastasectomy on a minimally invasive plateform (robotic) can be used for an R0 resection in patients who have retroperitoneal metastasis from rectal cancer after control of the primary tumor.

DOI # http://dx.doi.org/10.17797/wd7d09sjgc

Advanced

Procedure

Robotic inferior mesenteric artery, common iliac artery, and retroperitoneal lymph node dissection for metastatic rectal cancer to achieve an R0 resection after complete removal of the primary lesion.

Indications

Colorectal cancer remains one of the most common malignancies in the United States, with stage IV disease historically having only a 10% 5 year survival. The indications for metastasectomy have been expanded as past studies have shown survival advantages. Initially a survival advantage was seen only in hepatic metastasectomies, followed by lung, however with improved outcomes with modern multidrug chemotherapy the indications for resecting metastatic lesions such as retroperitoneal, ovary, peritoneal cavity and brain metastasis have shown survival advantages. With a good response from chemotherapy and complete resection of the primary lesion, metastatic lesions have now become indicated as certain studies have shown a proven survival advantage (16 months in the metastasectomy patients vs. 6.7 months in patients with pelvic metastatic disease).

Contraindications

Patients unfit to undergo operative intervention, patients with widely metastatic disease without ability to achieve an R0 resection. Conversely, in other situations, patients may be candidates for heated intraperitoneal chemotherapy (HIPEC) with an R1 resection).

Instrumentation

Setup

Supine positioning, general anesthesia, Si or Xi DaVinci robot (Si shown)

Preoperative Workup

Computed tomography with or without positron emission tomography or other cross-sectional imaging, blood tumor markers

Anatomy and Landmarks

In the retroperitonum: lumbar vessels, ureter, sciatic nerve, gonadal veins, iliac arteries, aorta, inferior vena cava, psoas muscle.

Advantages/Disadvantages

There is an increased morbidity and stress response for these procedures in open surgery which may limit their indications, however robotic surgery as a minimally invasive platform provides significant operative and postoperative advantages which may make these operations feasible to a more diverse patient population. Disadvantage is bleeding, infection and damage to nearby structures.

Complications/Risks

Complications and risk similar to other operations, open, laparoscopic or robotic.

Disclosure of Conflicts

Complications and risk similar to other operations, open, laparoscopic or robotic.

Acknowledgements

Memorial Sloan Kettering Cancer Center, New York, NY

References

Mahmoud, N & Dunn, Bullard K, Metastasectomy for Stage IV Colorectal Cancer, Dis Colon Rectum 2010; 53: 1080�1092

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