Τίτλος:
An anatomic anal sphincter-saving procedure for rectal cancers located at anorectal junction
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: This study aims to present the feasibility of the open approach of hemilevator excision (HLE) as a promising alternative of the laparoscopic and/or robotic ones for the treatment of low rectal cancer extending to the ipsilateral puborectalis muscle. Methods: A 60-year-old male patient with a high-grade differentiated rectal adenocarcinoma at the right side of the lower rectum invading puborectalis muscle. The proposed operation consists of a combination of extralevator abdomino-perineal excision (ELAPE), intersphicteric resection (ISR), and low anterior resection (LAR) since it resects the ipsilateral to tumor levator ani muscle (LAM) from its attachment at the internal obturator fascia and the deep part of ipsilateral external anal sphincter (EAS), while the distal part of dissection is completed in the intersphincteric space taking out the internal anal sphincter (IAS). At the contralateral side of the tumor, the dissection plane follows the classic route of LAR. Results: Pathology proved the oncologic adequacy of resection. MRI at the fourth postoperative week showed clearly the right aspect of anorectal junction free of tumor. Anorectal manometry revealed a fair anorectal function which is in accordance with the findings of clinical assessment of patient after restoring large bowel continuity (post-op Wexner score, 7). Conclusion: This is the first case of the open HLE that seems to be a good alternative compared to ELAPE or conventional APR, as it offers oncologic adequacy and a fair anorectal function. © 2019 The Author(s).
Συγγραφείς:
Mariolis-Sapsakos, T.
Psathas, G.
Nikolouzakis, T.K.
Laschos, K.
Triantopoulou, C.
Bonatsos, G.
Tsiaoussis, J.
Περιοδικό:
World Journal of Surgical Oncology
Εκδότης:
BioMed Central Ltd.
Λέξεις-κλειδιά:
adult; anorectal pressure; anus sphincter; artery ligation; Article; body position; cancer adjuvant therapy; case report; clinical article; colorectal anastomosis; extralevator abdomino perineal excision; feces incontinence; hemilevator excision; human; ileostomy; intersphicteric resection; intestine function; laparoscopic surgery; levator ani muscle; Lloyd Davis position; low anterior resection; male; middle aged; nuclear magnetic resonance imaging; open surgery; organ preservation; postoperative period; puborectalis muscle; rectum carcinoma; rectum surgery; robot assisted surgery; vein ligation; Wexner score; anal canal; diagnostic imaging; laparoscopy; pathology; perineum; procedures; rectum; rectum tumor, Anal Canal; Humans; Laparoscopy; Magnetic Resonance Imaging; Male; Middle Aged; Perineum; Rectal Neoplasms; Rectum; Robotic Surgical Procedures
DOI:
10.1186/s12957-019-1672-y
