Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report
Abstract Background Anorectal fistula cancer is often diagnosed in an advanced state, and radical resection is difficult when invasion of the pelvic wall is observed. In addition, there is currently no clear evidence for perioperative treatment of locally advanced cases. We report a case of anorecta...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-11-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-023-01778-6 |
| _version_ | 1827708766105108480 |
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| author | Takuya Inoue Yuki Sekido Takayuki Ogino Tsuyoshi Hata Norikatsu Miyoshi Hidekazu Takahashi Mamoru Uemura Tsunekazu Mizushima Yuichiro Doki Hidetoshi Eguchi |
| author_facet | Takuya Inoue Yuki Sekido Takayuki Ogino Tsuyoshi Hata Norikatsu Miyoshi Hidekazu Takahashi Mamoru Uemura Tsunekazu Mizushima Yuichiro Doki Hidetoshi Eguchi |
| author_sort | Takuya Inoue |
| collection | DOAJ |
| description | Abstract Background Anorectal fistula cancer is often diagnosed in an advanced state, and radical resection is difficult when invasion of the pelvic wall is observed. In addition, there is currently no clear evidence for perioperative treatment of locally advanced cases. We report a case of anorectal fistula cancer with widespread infiltration diagnosed during the course of Crohn’s disease, which was curatively resected after preoperative chemoradiotherapy. Case presentation A 49-year-old man who had been diagnosed with Crohn’s disease (ileocolonic type) at the age of 25 and was found to have an anorectal fistula and perianal abscess at the age of 44 was referred to our department with complaints of abdominal pain and diarrhea. Computed tomography (CT) showed anal stenosis due to a pelvic mass. Pathological analysis of a biopsy taken under general anesthesia indicated mucinous carcinoma. Magnetic resonance imaging (MRI) revealed infiltration into the prostate, seminal vesicles, levator ani muscle, and left internal obturator muscle, and the patient was diagnosed with cT4N0M0 cStage IIIB anorectal fistula cancer (UICC TNM classification 8th edition). After performing a laparoscopic sigmoid colostomy, chemoradiation therapy (capecitabine + oxaliplatin, 50.4 Gy/28fr) was initiated. The patient then underwent laparoscopic total pelvic exenteration, colonic conduit diversion, extensive perineal resection, and reconstruction using bilateral gluteus maximus flaps and a right rectus abdominis musculocutaneous flap. The pathological diagnosis was mucinous adenocarcinoma, pT4, and all margins were negative. No recurrence was evident 6 months after the operation without adjuvant chemotherapy. Conclusion We described a case of curative resection after preoperative chemoradiotherapy for anorectal fistula cancer with extensive invasion that was diagnosed during the course of Crohn’s disease.An accumulation of cases is needed to determine the usefulness of preoperative chemoradiation therapy for local control of anorectal fistula cancer associated with Crohn’s disease. |
| first_indexed | 2024-03-10T17:09:16Z |
| format | Article |
| id | doaj.art-b89fa411e9a14898bd1cd2e9de9a1b21 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-03-10T17:09:16Z |
| publishDate | 2023-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-b89fa411e9a14898bd1cd2e9de9a1b212023-11-20T10:43:16ZengSpringerOpenSurgical Case Reports2198-77932023-11-01911610.1186/s40792-023-01778-6Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case reportTakuya Inoue0Yuki Sekido1Takayuki Ogino2Tsuyoshi Hata3Norikatsu Miyoshi4Hidekazu Takahashi5Mamoru Uemura6Tsunekazu Mizushima7Yuichiro Doki8Hidetoshi Eguchi9Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Osaka Police HospitalDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityAbstract Background Anorectal fistula cancer is often diagnosed in an advanced state, and radical resection is difficult when invasion of the pelvic wall is observed. In addition, there is currently no clear evidence for perioperative treatment of locally advanced cases. We report a case of anorectal fistula cancer with widespread infiltration diagnosed during the course of Crohn’s disease, which was curatively resected after preoperative chemoradiotherapy. Case presentation A 49-year-old man who had been diagnosed with Crohn’s disease (ileocolonic type) at the age of 25 and was found to have an anorectal fistula and perianal abscess at the age of 44 was referred to our department with complaints of abdominal pain and diarrhea. Computed tomography (CT) showed anal stenosis due to a pelvic mass. Pathological analysis of a biopsy taken under general anesthesia indicated mucinous carcinoma. Magnetic resonance imaging (MRI) revealed infiltration into the prostate, seminal vesicles, levator ani muscle, and left internal obturator muscle, and the patient was diagnosed with cT4N0M0 cStage IIIB anorectal fistula cancer (UICC TNM classification 8th edition). After performing a laparoscopic sigmoid colostomy, chemoradiation therapy (capecitabine + oxaliplatin, 50.4 Gy/28fr) was initiated. The patient then underwent laparoscopic total pelvic exenteration, colonic conduit diversion, extensive perineal resection, and reconstruction using bilateral gluteus maximus flaps and a right rectus abdominis musculocutaneous flap. The pathological diagnosis was mucinous adenocarcinoma, pT4, and all margins were negative. No recurrence was evident 6 months after the operation without adjuvant chemotherapy. Conclusion We described a case of curative resection after preoperative chemoradiotherapy for anorectal fistula cancer with extensive invasion that was diagnosed during the course of Crohn’s disease.An accumulation of cases is needed to determine the usefulness of preoperative chemoradiation therapy for local control of anorectal fistula cancer associated with Crohn’s disease.https://doi.org/10.1186/s40792-023-01778-6Anorectal fistula cancerChemoradiotherapyTotal perineal exenterationCrohn’s disease |
| spellingShingle | Takuya Inoue Yuki Sekido Takayuki Ogino Tsuyoshi Hata Norikatsu Miyoshi Hidekazu Takahashi Mamoru Uemura Tsunekazu Mizushima Yuichiro Doki Hidetoshi Eguchi Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report Surgical Case Reports Anorectal fistula cancer Chemoradiotherapy Total perineal exenteration Crohn’s disease |
| title | Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report |
| title_full | Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report |
| title_fullStr | Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report |
| title_full_unstemmed | Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report |
| title_short | Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report |
| title_sort | resection of anorectal fistula cancer associated with crohn s disease after preoperative chemoradiotherapy a case report |
| topic | Anorectal fistula cancer Chemoradiotherapy Total perineal exenteration Crohn’s disease |
| url | https://doi.org/10.1186/s40792-023-01778-6 |
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