Behind the knife

Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis.
Episode 3 outlines the radical technical approaches to posterior and laterally invasive tumours, including en bloc iliac vascular resection and reconstruction, as well as radical sacrectomy techniques. Each episode in this series features a different international guest surgeon. In episode 3, the RPA team are joined by Dr Oliver Peacock from the University of Texas MD Anderson Cancer Centre, USA. Technical descriptions and videos: Shaikh I, Holloway I, Aston W, Littler S, Burling D, Antoniou A, Jenkins JT; Complex Cancer Clinic St Mark's Hospital London. High subcortical sacrectomy: a novel approach to facilitate complete resection of locally advanced and recurrent rectal cancer with high (S1-S2) sacral extension. Colorectal Dis. 2016 Apr;18(4):386-92. doi: 10.1111/codi.13226. PMID: 26638828. https://pubmed.ncbi.nlm.nih.gov/26638828/ Brown KGM, Solomon MJ, Austin KKS, Lee PJ, Stalley P. Posterior high sacral segmental disconnection prior to anterior en bloc exenteration for recurrent rectal cancer. Tech Coloproctol. 2016 Jun;20(6):401-404. doi: 10.1007/s10151-016-1456-0. Epub 2016 Mar 21. PMID: 27000857. https://pubmed.ncbi.nlm.nih.gov/27000857/ Sutton PA, Solomon M, Sasidharan P, Lee P, Austin K. Abdominolithotomy sacrectomy for the management of locally recurrent rectal cancer: video vignette. Br J Surg. 2021 Aug 19;108(8):e257. doi: 10.1093/bjs/znab105. PMID: 34089593. https://pubmed.ncbi.nlm.nih.gov/34089593/ Drami I, Fletcher JA, Corr A, West MA, Aston W, Hellawell G, Burns EM, Jenkins JT. Total pelvic exenteration with 'high and wide' sacrectomy for recurrent rectal cancer: A video vignette. Colorectal Dis. 2022 Dec;24(12):1625-1626. doi: 10.1111/codi.16230. Epub 2022 Jul 18. PMID: 35730692. https://pubmed.ncbi.nlm.nih.gov/35730692/ References: Rajendran S, Brown KGM, Solomon MJ. Oncovascular surgery for advanced pelvic malignancy. Br J Surg. 2023 Jan 10;110(2):144-149. doi: 10.1093/bjs/znac414. PMID: 36427187. https://pubmed.ncbi.nlm.nih.gov/36427187/ Austin KK, Solomon MJ. Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum. 2009 Jul;52(7):1223-33. doi: 10.1007/DCR.0b013e3181a73f48. PMID: 19571697. https://pubmed.ncbi.nlm.nih.gov/19571697/ Rogers AC, Jenkins JT, Rasheed S, Malietzis G, Burns EM, Kontovounisios C, Tekkis PP. Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer. J Clin Med. 2021 Oct 25;10(21):4921. doi: 10.3390/jcm10214921. PMID: 34768442; PMCID: PMC8584798. https://pubmed.ncbi.nlm.nih.gov/34768442/ van Kessel CS, Waller J, Steffens D, Lee PJ, Austin KKS, Stalley PD, Solomon MJ. Improving Surgical Outcomes in Pelvic Exenteration Surgery: Comparison of Prone Sacrectomy with Anterior Cortical Sacrectomy Techniques. Ann Surg. 2023 Jul 24. doi: 10.1097/SLA.0000000000006040. Epub ahead of print. PMID: 37485983. https://pubmed.ncbi.nlm.nih.gov/37485983/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.