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

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.

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).

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).

Robotic Surgical System

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

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

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

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

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

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