Robotic Low Anterior Resection and Partial Bladder Resection for Management of Locoregional Endometrial Cancer Recurrence

Bladder Cancer
17/06/2020

Khadraoui W, et al. J Minim Invasive Gynecol 2020.

ABSTRACT

OBJECTIVE: To demonstrate a robotic tumor debulking for management of locoregional endometrial cancer recurrence.

DESIGN: A case report.

SETTING: A tertiary referral center in New Haven, CT.

INTERVENTIONS: 70-year-old with history of stage IB endometrioid endometrial cancer presented three years after completion of treatment with rectal bleeding. A mass involving the distal sigmoid colon/upper rectum and bilateral distal peri-ureteral masses were visualized on imaging. There was no distant metastatic disease. Colonoscopic biopsies were consistent with endometrial cancer recurrence. Given that patient was symptomatic with rectal bleeding and had no distant metastasis, she was recommended to undergo surgical resection for management of this locoregional recurrence. Patient was placed in reverse Trendelenburg position with a rightward tilt to mobilize the splenic flexure. Once the cephalad aspect of descending colon mobilization was completed, the patient was placed in Trendelenburg lithotomy position to expose the pelvis. Robot was docked at this point and the pelvic avascular spaces were delineated. A medial-to-lateral approach was utilized in mobilization of the sigmoid colon mesentery. Left ureter was identified and the sigmoid branches of IMA were sealed. The descending/sigmoid colon junction was stapled. After complete mobilization of the sigmoid colon, the tumor-free upper rectum was delineated and stapled. Attention was then turned to the distal peri-ureteral masses. The 2 cm mass on the right which was densely adherent to the distal right ureter was completely resected after extensive ureterolysis. The resection of the 4 cm mass on the left which involved both the distal left ureter and the bladder dome required an intentional cystotomy and partial cystectomy to attain negative margins. Procedure was continued with the bowel anastomosis. The anvil was introduced through the vagina and was placed into the proximal limb via an antimesenteric incision. An end-to-end tension-free anastomosis was performed and adequate vascularization was confirmed with IV indocyanine green.

CONCLUSION: Robotic LAR and partial bladder resection were performed without any complications with negative margins. Robotic tumor debulking should be considered in appropriate patients, when managing locoregional recurrence of endometrial cancer (1,2).