You are here

  • Home
  • Online First
  • Rectal sparing in modified posterior exenteration: description of the technique in 10 steps

Article Text

Article menu

Download PDFPDF

Video article
Rectal sparing in modified posterior exenteration: description of the technique in 10 steps
  1. Navid Mokarram Dorri1,
  2. Guillaume Blache1,
  3. Jonathan Garnier1,
  4. Gilles Houvenaeghel1,2,
  5. Houssein El Hajj1 and
  6. Eric Lambaudie1,2
    1. 1Surgical Oncology Department, Paoli-Calmettes Institute, Marseille, France
    2. 2Université Aix Marseille, Inserm, CNRS, Institut Paoli Calmettes, Marseille, France
    1. Correspondence to Dr Navid Mokarram Dorri, Paoli-Calmettes Institute, Marseille, France; mokarramdorrin{at}ipc.unicancer.fr

    https://doi.org/10.1136/ijgc-2023-004994

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Background

      To achieve complete cytoreduction in ovarian carcinoma, rectal resection may be necessary in the case of gastrointestinal tract involvement.1 Posterior resection surgeries were described by Eiseinkopt and Bristow who modified Hudson’s pelvic peritonectomy.2

      The concept of digestive sparing has been developed for several years. We propose a modified surgical approach of posterior resection by combining three principles (Hudson-type dissection, pushed Douglasectomy, and first stapling of the rectum) to optimize rectal sparing.3 4

      Method

      Video 1 shows an 10-steps ‘en bloc’ pelvic peritonectomy combined with digestive resection, illustrating the first stapling of the rectum. We associated other digestive resection during this procedure not present in Video 1 (peritonectomy of the right diaphragmatic dome, mesentery and mesocolon). The surgery was performed by a senior surgeon and an assistant from the department.

      Video 1 ‘En bloc’ pelvic resection: section of anterior and lateral part of vagina and beginning of the Douglasectomy. (a) Vagina. (b) Right ureter. (c) Cervix. (d) Mesorectum.

      Results

      The surgical procedure is divided into 10 steps:

      Step 1: Supra-pelvic and intra-peritoneal approach

      Step 2: Pelvic and retro-peritoneal approach

      Step 3: Uterine vessel ligature

      Step 4 : Ureterolysis

      Step 5 : Pre-vesical peritonectomy

      Step 6: Para-rectal space dissection

      Step 7: ‘Hanging’ en bloc specimen

      Step 8: Retrograde dissection of rectovaginal septum and Douglas pouch dissection

      Step 9: First rectal stapling

      Step 10: Proximal bowel division

      Conclusions

      In our experience, the first section of the rectum is always feasible if the three principles are combined (Hudson-type dissection, advanced Douglasectomy, and first stapling of the rectum). The advantages of rectal sparing are that it allows an anastomosis to be made on the upper rectum, avoids lowering the left colonic angle, makes it very easy to combine other digestive resections ‘en bloc’, and facilitates repeat rectal resections in the case of recurrence. Standardization of this procedure will help young surgeons to learn the methodology and better grasp the steps involved.

      Ethics statements

      Patient consent for publication

      Ethics approval

      Not applicable.

      Acknowledgments

      Illustrations by Ludovic Chaix.

      References

      1. ↵
        1. Barnes W,
        2. Johnson J,
        3. Waggoner S, et al
        . Reverse hysterocolposigmoidectomy (RHCS) for resection of panpelvic tumors. Gynecol Oncol 1991;42:151–5. doi:10.1016/0090-8258(91)90336-4
        OpenUrlCrossRefPubMed
      2. ↵
        1. William Helm C
        . Hudson’s landmark contribution to ovarian cancer surgery. BJOG 2016;123:2190. doi:10.1111/1471-0528.13999
        OpenUrl
      3. ↵
        1. Angeles MA,
        2. Martínez-Gómez C,
        3. Martinez A, et al
        . En bloc pelvic resection for ovarian carcinomatosis: Hudson procedure in 10 steps. Gynecol Oncol 2019;153:209–10. doi:10.1016/j.ygyno.2018.12.006
        OpenUrl
      4. ↵
        1. Rosati A,
        2. Vargiu V,
        3. Santullo F, et al
        . Rectosigmoid mesorectal-sparing resection in advanced ovarian cancer surgery. Ann Surg Oncol 2021;28:6721–2. doi:10.1245/s10434-021-09651-2
        OpenUrl

      Footnotes

      • Twitter @Blache Guillaume, @housseinelhajj3

      • Contributors NMD: Conceptualization, video editing, surgery, video recording, voice recording, writing - original draft. GB: Conceptualization, video editing, surgery, video recording, supervision, writing - original draft. JG, GH, HEH: Conceptualization. EL: Conceptualization, supervision. EL critically revised the manuscript for intellectual content. All authors read and approved the final draft.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.