VM101 - Robotic Partial Prostatectomy and APR for Rectal Cancer

Purpose/Background: A 57 year old man presented to our clinic with rectal bleeding and a palpable rectal mass. He underwent a colonoscopy that demonstrated a 2cm fungating, ulcerated distal rectal mass extending to the ano-rectal margin, biopsy demonstrated invasive moderately differentiated adenocarcinoma. He underwent an MRI pelvis that demonstrated a 2.5cm anterior low rectal mass approximately 4.5cm from the anal verge. He underwent long course chemoradiation followed by chemotherapy and subsequent staging imaging that demonstrated progression of disease with involvement of the prostate and levators.

Methods/Interventions: After presentation at a multi-disciplinary tumor board, he was recommended to undergo pelvic exenteration with an abdominal perineal resection and prostatectomy. He deferred surgery with the pandemic, underwent additional chemotherapy, and had a re-staging MRI that showed slight decrease in tumor size. He sought multiple opinions in hopes for a minimally invasive option.

Results/Outcomes: He underwent a robotic APR with partial prostatectomy. The superior two-thirds of the peripheral zone of the prostate was removed with the tumor en bloc to ensure a negative margin. The ventral horn of the peripheral zone was kept intact to preserve the neurovascular bundle. Final pathology showed direct invasion of the rectal tumor into the periprostatic soft tissue and margins negative for tumor. On 2 1/2 year follow up, he remains disease free with good urinary function. He does complain of a parastomal hernia and erectile dysfunction.

Conclusion/Discussion: When faced with a low anterior rectal tumor invading the prostate, a minimally invasive approach can be considered with resection of the peripheral zone of the prostate to minimize injury to the neurovascular bundle and minimize urinary dysfunction post-operatively.