» Articles » PMID: 32092693

Robotic-assisted Complete Mesocolic Excision, Central Vascular Ligation and Para-aortic Lymph Node Dissection in Multifocal Carcinoid: A Case Report and Technical Description

Overview
Specialty General Surgery
Date 2020 Feb 25
PMID 32092693
Citations 1
Authors
Affiliations
Soon will be listed here.
Abstract

Introduction: Neuroendocrine tumours are the most common type of primary small bowel neoplasm. Consensus guidelines recommend a multimodal approach to treatment of such tumours, with aggressive surgical resection remaining the mainstay of management. There is evidence that complete mesocolic excision (CME) of lymph nodes is associated with superior oncological outcomes including longer disease-free survival in patients with colorectal cancer than standard lymph node dissection and there is increasing evidence to suggest that the robotic approach may be superior to laparoscopic or open CME. This report discusses a robotic-assisted approach to CME with central vessel ligation (CVL) and para-aortic lymph node dissection in a case of multifocal neuroendocrine tumour of the small bowel.

Presentation Of Case And Technical Approach: This report details the case of a 73-year-old male with multifocal small bowel neuroendocrine tumour. He underwent a robotic-assisted right hemicolectomy, small bowel resection, CME, CVL and para-aortic lymph node dissection. The approach described involved undertaking CME, CVL and bowel resection with a standard right hemicolectomy robotic set-up before re-docking the robot to perform the retroperitoneal para-aortic lymph node dissection.

Discussion: This case highlights the management of multifocal small bowel neuroendocrine tumour using a robotic approach for surgical resection and lymph node clearance.

Conclusion: The robotic approach provides a safe and effective technique for undertaking surgical resection of small bowel neuroendocrine tumour as well as complete mesocolic excision of lymph nodes. With a change in port positions, a robotic approach can be utilised for CME/CVL as well as retroperitoneal node dissection.

Citing Articles

Complete Mesocolic Excision for Colon Cancer: The New Standard of Care?.

Rawat S, Aggarwal S, Parikh P, Chaudhary A, Kumar M, Sharma M South Asian J Cancer. 2025; 13(4):251-258.

PMID: 40060350 PMC: 11888812. DOI: 10.1055/s-0044-1801754.


Lateral lymph node dissection can increase overall survival and 5‑year survival rate of rectal cancer patients: A meta‑analysis.

Zou B, Ning N, Yan Y, Zhang Y Oncol Lett. 2024; 27(2):80.

PMID: 38249814 PMC: 10797321. DOI: 10.3892/ol.2024.14214.

References
1.
Howe J, Cardona K, Fraker D, Kebebew E, Untch B, Wang Y . The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017; 46(6):715-731. PMC: 5502737. DOI: 10.1097/MPA.0000000000000846. View

2.
Negoi I, Hostiuc S, Negoi R, Beuran M . Laparoscopic open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis. World J Gastrointest Oncol. 2018; 9(12):475-491. PMC: 5740088. DOI: 10.4251/wjgo.v9.i12.475. View

3.
Agha R, Borrelli M, Farwana R, Koshy K, Fowler A, Orgill D . The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018; 60:132-136. DOI: 10.1016/j.ijsu.2018.10.028. View

4.
Gouvas N, Agalianos C, Papaparaskeva K, Perrakis A, Hohenberger W, Xynos E . Surgery along the embryological planes for colon cancer: a systematic review of complete mesocolic excision. Int J Colorectal Dis. 2016; 31(9):1577-94. DOI: 10.1007/s00384-016-2626-2. View

5.
Bertelsen C, Neuenschwander A, Erik Jansen J, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma J . Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol. 2015; 16(2):161-8. DOI: 10.1016/S1470-2045(14)71168-4. View