Simultaneous Robot-Assisted Abdominoperineal Rectal Extirpation and Radical Prostatectomy for Synchronous Rectal and Prostate Adenocarcinomas.
Mahmoud Farzat, Ibrahim Al-Taie, Florian M Wagenlehner et al.
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Case in brief
A 79-year-old man had synchronous distal rectal adenocarcinoma (cT3 cN1 cM0) and prostate adenocarcinoma (cT1c cN0 cM0, Gleason 4 + 3 = 7). After neoadjuvant radiochemotherapy for the rectal tumor, restaging showed a good local response. He underwent a planned single-stage robot-assisted abdominoperineal rectal extirpation with total mesorectal excision and terminal descendostomy, followed by radical prostatectomy and bilateral pelvic lymphadenectomy. Pathology showed rectal ypT1 pN0 (0/19) R0 disease with 30% vital tumor and prostate ypT3a pN0 R0 disease. He was discharged on day 8 with initial signs of good recovery.
What made this case unusual
The two synchronous cancers required major operations in the same confined pelvic space; the report describes completing both resections robotically in one planned session.
Diagnostic / clinical pearl
When rectal and prostate adenocarcinomas coexist, assess both tumors and their treatment requirements to plan surgery around the shared pelvic space; this case illustrates a single-stage robotic approach in a carefully selected patient.