VM103 - Rectal Cancer and the Frozen Abdomen- Robotic Surgery Makes the Impossible Possible

Saturday, June 1, 2024

10:00 AM – 1:30 PM ET, USA

Location: Baltimore Convention Center, Hall BCD

Senior Author(s)

MD

Michael E. Dolberg, MD, FACS, FASCRS

Colorectal Surgeon
Memorial Healthcare System
Pembrooke Pines, Florida, United States

Disclosure information not submitted.

Video Presentation(s)

Natalie Ceballos, MD

General Surgery Resident
Memorial Healthcare System
Memorial Healthcare System
Hollywood, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

CS

Chelsea Spector, MD

General Surgery Resident
Memorial Healthcare System
Hollywood, Florida, United States

Disclosure information not submitted.
LC

Lucia Castro Hernandez, MD

General Surgery Resident
Memorial Healthcare System
Hollywood, Florida, United States

Disclosure information not submitted.
DW

Dylan A. Wadell, MD

General Surgery Resident
Memorial Healthcare System
Hollywood, Florida, United States

Disclosure information not submitted.

Purpose/Background: This is a case of a 70-year-old male with a history including Crohn's disease and prior ileocolic resection for stricture now presenting with a T2N1 low rectal cancer with internal anal sphincter involvement and a right groin lymph node that was positive for metastatic disease. He underwent total neoadjuvant therapy (TNT) as per multidisciplinary tumor board recommendations.

Methods/Interventions: Upon completion of TNT, he presented for surgical resection. Re-staging MRI demonstrated response to treatment as well as an enterocutaneous fistula. He underwent an extensive robotic lysis of adhesions, robotic abdominoperineal resection, with the use of fluorescence angiography, takedown of an enterocutaneous fistula, and drainage of a pelvic abscess.

Results/Outcomes: The patient recovered well post-operatively. The final pathology revealed a 5cm invasive rectal adenocarcinoma with mucinous features with negative margins and nine lymph nodes negative for tumor. Pathologic staging was T2N0.

Conclusion/Discussion: This video showcases the advantages of robotic surgery in a complex case with a frozen abdomen. The video includes a demonstration of an extensive lysis of adhesions required to obtain adequate exposure of the rectum as well as a careful low rectal dissection. This video also demonstrates the utilization of a prone specimen extraction further minimizing surgical incisions. The robotic platform makes minimally invasive surgery possible even in the most complex situations.