Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
| Autor: | Desmond Toomey, Enda Hannan, Jessica M. Ryan |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Radiation proctitis Colorectal cancer medicine.medical_treatment PC prostate cancer External beam radiotherapy Context (language use) Article 03 medical and health sciences 0302 clinical medicine medicine ERBT external beamradtiotherapy Rectal cancer Rectal Polyp Prostate cancer Rectal tumours business.industry Colostomy medicine.disease TAMIS 030220 oncology & carcinogenesis Anal verge AR anterior resection 030211 gastroenterology & hepatology Surgery Radiology Segmental resection business TAMIS transanal minimally invasive surgery |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Anterior resection following pelvic irradiation is highly challenging. • Non-restorative procedures allow a high-risk anastomosis to be avoided. • Transanal minimally invasive surgery is useful for early cancer and benign polyps. • Segmental wedge resection may be beneficial in select cases. • Tailoring and individualising treatment is essential to improve outcomes. Introduction The aftermath of pelvic radiotherapy for prostate cancer (PC) can pose a significant challenge for surgeons in the management of rectal and sigmoid tumours, resulting in extensive fibrosis and difficult anatomy. Higher rates of ureteric injuries and anastomotic leakage following anterior resection (AR) have been reported with no clear consensus for an optimal approach. We present three cases, each employing a different surgical approach tailored to the individual patient-specific and disease-specific factors. Presentation of case In each case, the patient had active radiation proctitis. Case 1 was a T3 rectal cancer 9 cm from the anal verge. A non-restorative procedure was performed with a permanent end colostomy, due to the extensive pelvic fibrosis encountered in a comorbid patient. In case 2, a large rectal polyp at 12 cm from the anal verge was managed using transanal minimally invasive surgery (TAMIS) with a covering loop ileostomy. In case 3, an elderly patient with dementia with a malignant sigmoid polyp underwent a segmental resection rather than standard oncological resection, thus avoiding either a stoma or rectal anastomosis in the context of active radiation proctitis. All three patients remain well at follow-up with no evidence of recurrence. Discussion All three cases demonstrate an individualised approach, taking into account specific factors relating to both patient and disease. In all cases, the presence of active chronic radiation proctitis meant that primary colorectal anastomosis was not safe, thus, alternative approaches were taken. Conclusion It is essential to tailor treatment according to patient-specific and disease-specific factors. |
| Databáze: | OpenAIRE |
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