Robotic-assisted soft-tissue pelvic exenteration for primary and recurrent pelvic tumours: IDEAL stage 2a evaluation

Abstract

Pelvic exenteration (PE) can cure advanced cases of locally advanced primary and recurrent pelvic cancers1–3. Outcomes following PE are optimized when managed by high-volume multidisciplinary teams2–4. Currently, most PE procedures are performed by open surgery with severe surgical morbidity reported in up to 60 per cent of cases2,3. Minimally invasive surgery (MIS) has numerous benefits in abdominopelvic surgery, including reduced blood loss, reduced morbidity, and reduced duration of hospital stay5,6. The application of minimally invasive PE has been limited owing to the anatomical limitations of the bony pelvis; however, robotic surgery platforms can overcome many of these challenges. In 2018, a systematic review comparing open and minimally invasive PE reporting on 170 patients demonstrated that MIS-PE was associated with reduced intraoperative blood loss, reduced morbidity, and shorter duration of hospital stay7. Reports of robotic PE are limited8 to single-centre case series and video vignettes from high-volume centres9–12. To progress robotic PE, it is important to standardize and refine operative techniques, further understand operative and oncological outcomes, and define training requirements and core outcome measures.