Madrid, 29 June, 2023.The most frequent types of cancer diagnosed in men in Spain in 2023 will be those of the prostate, colon and rectum, and bladder(1). Many patients with these types of tumours may require either tumour excision surgery or the removal of the affected organs. In the event of advanced stage cancer or more than one condition, pelvic exenteration may be necessary. This involves complex surgery to remove the pelvic organs: the lower colon, rectum, bladder and/or prostate. Given its complexity, this procedure generally requires the collaboration of two teams, specialists in urology and digestive oncology.
With the aim of improving the process and reducing morbidity, the multidisciplinary team at MD Anderson Cancer Center Madrid has published an article in the journal Spanish Surgery presenting a systematisation of male pelvic exenteration surgery using the Da Vinci robot(2). This minimally invasive robotic approach simplifies the intervention by enabling 3D visualisation and greater flexibility of movement. As a result, it reduces the risk of complications and sequelae, such as pain, erectile dysfunction or urinary incontinence, among other side effects. The monographic hospital is one of the few centres in Spain that employs this innovative approach for the benefit of its patients.
As Dr. Óscar Alonso Casado, specialist in Digestive Surgical Oncology and robotic surgery explains, “in general we are dealing with complex surgery. In recent years, in selected cases, we could use laparoscopy for this, but this was always a difficult process because the pelvis is a narrow anatomical area restricted by the bone and in which any movement of the instruments is complicated. What we achieve with the robot is to make the technique much easier, both when it comes to an isolated bladder or rectum tumour, or when a larger tumour is involved that affects all organs."
Doctors Gloria Ortega Pérez and Irene López Rojo, from the Surgical Oncology and General and Digestive Surgery Department of MD Anderson Madrid, and Dr. Carlos Núñez, head of the Urological Surgery Department of the same hospital, also contributed to this publication.
The importance of systematising the procedure
Dr. Alonso Casado argues that the systematisation of the technique is essential when it comes to reducing surgery time and the consequences for the patient. It is about establishing an order, a sequence to the surgical gestures performed during the procedure, making it possible to speed up the process and reduce the number of holes made. Systemising the technique plays a fundamental role in preventing unexpected events and ensuring that there are no delays during surgery.
This in turn has a beneficial impact on patient safety, as the risk of unexpected bleeding is reduced and recovery will be faster and easier, meaning that patients can move on to chemotherapy much sooner if necessary.
"What we propose in the publication is a systematisation based on three cases. Currently, the longest globally published series involved seven cases carried out by Dr. Michael Williams, urologist at the Royal Brisbane and Women's Hospital in Australia. Our aim now is to increase the number of patients studied in order to quantify the benefits of this technique", explains the specialist in Digestive Surgical Oncology at MD Anderson Madrid.
Next Steps: Publication of Effectiveness and Safety Results
For a more detailed analysis, the next objective for our multidisciplinary team is to increase the number of male cases in order to demonstrate that this procedure is completely safe from an oncological point of view and establish patient selection criteria; as such, complex cases require a careful selection of the profiles suitable for this type of surgery.
We have concentrated on the significance of these advances for the treatment of male tumours because the procedure is already more common on women. This is because the technique in the female sex is simpler since the pelvis is wider and there is no need to remove the prostate.
One area needing further work over the long term is the likelihood of tumour recurrence in cases involving the robotic pelvic exenteration using the Da Vinci system. According to our specialist at MD Anderson Madrid, "it is still too early to provide evidence that this technique can maintain or reduce the risk of relapse, since there are so few examples of patients undergoing surgery. However, what we usually do is select cases with specific conditions that enable the procedure to be performed with the guarantee that the surgical margin will be negative and that the risk of recurrence will not be any greater than if it were done with open surgery ".
References
- Spanish Society of Medical Oncology (SEOM) - Las Cifras del Cáncer 2023
- Alonso Casado O, et al. Robotic approach to male pelvic exenteration. Systematisation of the technique. Cir Esp. 2023. https://doi.org/10.1016/j.ciresp.2023.03.003