Stepwise Approach for Robotic Total Pelvic Exenteration with En Bloc Presacral Fascia in T4b Rectal Cancer.

Background: The T4 rectal cancers indicate beyond total mesorectal excision (TME) plane dissection with en bloc multivisceral resection for achieving R0 resection. Recent studies emphasize the feasibility and safety of minimally invasive surgery in selected T4 rectal cancers. This study demonstrates a stepwise approach for robotic total pelvic exenteration (TPE) with en bloc presacral fascia in T4b rectal cancer, focusing on the internal iliac vessel branches management and presacral fascia resection.