Combined transabdominal–transanal surgical approach for iatrogenic rectovaginal fistula: two case reports

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2021.0063 ◽

2021 ◽

Author(s):

P Wang ◽

W Tong ◽

Q Wang

Keyword(s):

Rectal Cancer ◽

Rectovaginal Fistula ◽

Case Reports ◽

Rectal Surgery ◽

Radical Resection ◽

Scar Tissue ◽

Vaginal Wall ◽

Vaginal Repair ◽

Transanal Resection ◽

Transanal Approach

Rectovaginal fistula (RVF) is a type of anastomotic leakage that may occur after low anterior resection for rectal cancer. The repair of RVF can be challenging because of the scar tissue stenosis and incomplete obstruction. Two patients presented in our department with vaginal faecal discharge almost 7 months after the radical resection of rectal cancer. On vaginal examination, titanium nails related to the rectal surgery were found in the vaginal wall. The patients were diagnosed with RVF. Considering that RVF positions in the patients were high and might adhere to the pelvic tissue, a combined transabdominal–transanal resection and vaginal repair surgery was performed. About 3 months after surgery, both patients underwent colonic closure surgery, with consequent good recovery. A combined transabdominal–transanal approach may provide distinct advantages in surgical repair of difficult cases of RVF.

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Transanal resection of rectal cancer: a review

International Surgery Journal ◽

10.18203/2349-2902.isj20193013 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2637

Author(s):

Wasif Raza ◽

Anil Kumar Lala

Keyword(s):

Rectal Cancer ◽

Minimally Invasive Surgery ◽

Transanal Endoscopic Microsurgery ◽

Transanal Minimally Invasive Surgery ◽

Rectal Tumors ◽

Recurrence Rates ◽

Transanal Resection ◽

Transanal Approach ◽

The World ◽

Endoscopic Microsurgery

As an alternative to conventional resection of rectal tumors with low morbidity, the transanal approach has become popular and in-demand. It’s been almost 30 years since the techniques for transanal resection have been evolving steadily. The revolution started with the advent of transanal endoscopic microsurgery in the 80’s. Later, the introduction of transanal minimally invasive surgery improved the access and visibility for surgeons across the world. Concerns have been raised about recurrence rates of cancers with transanal approach and success of subsequent salvage operations. This review is an attempt to concise the available techniques, their results and also to bring about a consensus as to whether it is worth to give our patients an option of transanal resection of rectal cancer.

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Successful Laparoscopy-assisted Repair of a Rectovaginal Fistula after Low Anterior Resection for Rectal Cancer: A Report of Two Cases

10.21203/rs.3.rs-94548/v1 ◽

2020 ◽

Author(s):

Hiroyuki Ohta ◽

Kyozo Hashimoto ◽

Tomoyuki Mizukuro ◽

Byonggu An ◽

Yumi Zen ◽

...

Keyword(s):

Rectal Cancer ◽

Connective Tissue ◽

Surgical Procedures ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Japanese Patients ◽

Vaginal Repair ◽

Diverting Stoma ◽

Double Stapling

Abstract Background: A rectovaginal fistula (RVF) after low anterior resection for rectal cancer is troublesome and refractory. Although various surgical procedures have been previously described, no definitive procedure has shown satisfactory outcomes. We present two consecutive Japanese patients who underwent successful surgery for a RVF after low anterior resection. Case presentation: The patients were a 61-year-old woman and a 64-year-old woman. They were admitted to our hospital with a chief complaint of fecal discharge from the vagina after low anterior resection using the double-stapling technique for rectal cancer. They were diagnosed with RVF. Local surgical procedures, including diverting ileostomy, were unsuccessful in previous hospitals. Therefore, we performed laparoscopy-assisted repair of the RVF. In both the patients, laparoscopically robust pelvic adhesions were dissected, and the sigmoid colon was transected just before the RVF. Thereafter, in combination with a perineal approach, the rectum along with a previous anastomosis and fistula were completely removed. Surgeries were completed after vaginal repair, redo coloanal anastomosis, and interposition of the dissected connective tissue. In both the patients, the postoperative courses were uneventful. They have complained of neither recurrence of any RVF nor fecal incontinence 1 year and 10 months respectively after diverting stoma closure.Conclusions: A laparoscopy-assisted procedure with reanastomosis and interposition of the perineal connective tissue can be an effective treatment for an RVF after low anterior resection for rectal cancer.

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Successful laparoscopy-assisted repair of a rectovaginal fistula after low anterior resection for rectal cancer: a report of two cases

Surgical Case Reports ◽

10.1186/s40792-021-01150-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hiroyuki Ohta ◽

Kyozo Hashimoto ◽

Tomoyuki Mizukuro ◽

Byonggu An ◽

Yumi Zen ◽

...

Keyword(s):

Rectal Cancer ◽

Connective Tissue ◽

Surgical Procedures ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Japanese Patients ◽

Vaginal Repair ◽

Satisfactory Outcome ◽

Double Stapling

Abstract Background Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is troublesome and refractory. Although various surgical procedures have been previously described, no definitive procedure has shown a satisfactory outcome. We present two consecutive Japanese patients who underwent successful surgery for an RVF after low anterior resection. Case presentation The patients were two women (61-year-old and a 64-year-old). They were admitted to our hospital with a chief complaint of fecal discharge from the vagina after low anterior resection using the double-stapling technique for rectal cancer. They were diagnosed with RVF. Local surgical procedures, including diverting ileostomy, were unsuccessful in previous hospitals. Therefore, we performed laparoscopy-assisted repair of the RVF. In both patients, laparoscopically robust pelvic adhesions were dissected, and the sigmoid colon was transected at just oral side to the RVF. Thereafter, in combination with a perineal approach, the rectum, along with a previous anastomosis and fistula, were completely removed. Surgeries were completed after vaginal repair, redo coloanal anastomosis, and interposition of the dissected connective tissue. In both patients, the postoperative courses were uneventful. They complained of neither recurrence of any RVF nor fecal incontinence 1 year and 10 months after diverting stoma closure. Conclusions A laparoscopy-assisted procedure with reanastomosis and interposition of the perineal connective tissue can be an effective treatment for RVF after low anterior resection for rectal cancer.

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The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02223-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

I-Li Lai ◽

Jeng-Fu You ◽

Yih-Jong Chern ◽

Wen-Sy Tsai ◽

Jy-Ming Chiang ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Local Recurrence ◽

Distant Metastasis ◽

Resection Margin ◽

Radical Resection ◽

Hazard Ratio ◽

Low Rectal Cancer ◽

Distal Resection Margin ◽

Lymph Node Yield

Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

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Treatment of a BRAF V600E Positive Ameloblastoma in a Pediatric Patient with MEK Inhibitor Monotherapy

FACE ◽

10.1177/27325016211005126 ◽

2021 ◽

pp. 273250162110051

Author(s):

Steven Daws ◽

Kongkrit Chaiyasate ◽

Arshi Lehal

Keyword(s):

Mapk Pathway ◽

Case Reports ◽

Radical Resection ◽

Mek Inhibitor ◽

Braf V600e Mutation ◽

Braf V600e ◽

Targeted Chemotherapy ◽

Odontogenic Epithelium ◽

Genetic Landscape ◽

Frequent Presence

Ameloblastomas are uncommon tumors of the odontogenic epithelium standardly treated with radical resection. Recent studies of the genetic landscape of ameloblastoma have revealed the frequent presence of the BRAF V600E mutation, suggesting a possible role for targeted chemotherapy. We present the case of a primary mandibular ameloblastoma found in a 13-year-old female with confirmed BRAF V600E mutation. Prior to invasive surgical intervention she was treated for 8 weeks with the MEK inhibitor trametinib, but her tumor demonstrated little radiographic, clinical, or histologic response. Previous case reports have shown ameloblastoma in adult patients to be responsive to other agents targeting the MAPK pathway. Our observations in the presented case demonstrate the need for further research into the utility of targeted chemotherapy in ameloblastoma treatment.

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Multimodal Treatment of cT3 Rectal Cancer in a Prospective Multi-Center Observational Study: Can Neoadjuvant Chemoradiation Be Omitted in Patients with an MRI-Assessed, Negative Circumferential Resection Margin?

Visceral Medicine ◽

10.1159/000514800 ◽

2021 ◽

pp. 1-8

Author(s):

Henry Ptok ◽

Frank Meyer ◽

Ingo Gastinger ◽

Benjamin Garlipp

Keyword(s):

Rectal Cancer ◽

Observational Study ◽

Circumferential Resection Margin ◽

Resection Margin ◽

Anal Verge ◽

Final Analysis ◽

Radical Resection ◽

Distant Recurrence ◽

Neoadjuvant Chemoradiation ◽

Recurrence Rates

Background/Aim: Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. Methods: By means of a prospective nationwide registry (n = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer <12 cm from the anal verge with a negative (>1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, n = 25; nCRT+TME, n = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). Results: In the TME-alone group, tumors were located closer to the anal verge (p = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (p = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; p = 0.268). Local recurrences occurred at a similar rate in the TME-alone (n = 1; 5.3%) and nCRT+TME groups (n = 3; 5.5%) (p = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (p = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. Conclusions: In this cohort of patients with rectal cancer located <12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

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Coexistence of Perineural Invasion and Lymph Node Metastases Is a Poor Prognostic Factor in Patients with Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy Followed by Radical Resection and Adjuvant Chemotherapy

Medical Principles and Practice ◽

10.1159/000363604 ◽

2014 ◽

Vol 23 (5) ◽

pp. 465-470 ◽

Cited By ~ 8

Author(s):

Chun-Ming Huang ◽

Ching-Wen Huang ◽

Ming-Yii Huang ◽

Chih-Hung Lin ◽

Chin-Fan Chen ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Perineural Invasion ◽

Locally Advanced ◽

Radical Resection ◽

Advanced Rectal Cancer ◽

Preoperative Chemoradiotherapy ◽

Locally Advanced Rectal Cancer ◽

Poor Prognostic Factor ◽

Node Metastases

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Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

Medicina ◽

10.3390/medicina57030286 ◽

2021 ◽

Vol 57 (3) ◽

pp. 286

Author(s):

Michał Jankowski ◽

Manuela Las-Jankowska ◽

Andrzej Rutkowski ◽

Dariusz Bała ◽

Dorian Wiśniewski ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Rectal Cancer Patient ◽

Radical Resection ◽

Single Center ◽

Curative Intent ◽

Immediate Surgery ◽

Histopathological Results ◽

Isolated Local Recurrence ◽

Recurrence Of Rectal Cancer

Background and Objectives: Despite advances in treatment, local recurrence remains a great concern in patients with rectal cancer. The aim of this study was to investigate the incidence and risk factors of local recurrence of rectal cancer in our single center over a 7-year-period. Materials and Methods: Patients with stage I-III rectal cancer were treated with curative intent. The necessity for radiotherapy and chemotherapy was determined before surgery and/or postoperative histopathological results. Results: Of 365 rectal cancer patients, 76 (20.8%) developed recurrent disease. In total, 27 (7.4%) patients presented with a local tumor recurrence (isolated in 40.7% of cases). Radiotherapy was performed in 296 (81.1%) patients. The most often used schema was 5 × 5 Gy followed by immediate surgery (n = 214, 58.6%). Local recurrence occurred less frequently in patients treated with 5 × 5 Gy radiotherapy followed by surgery (n = 9, 4%). Surgical procedures of relapses were performed in 12 patients, six of whom were operated with radical intent. Only two (7.4%) patients lived more than 5 years after local recurrence treatment. The incidence of local recurrence was associated with primary tumor distal location and worse prognosis. The median overall survival of patients after local recurrence treatment was 19 months. Conclusions: Individualized rectal cancer patient selection and systematic treatment algorithms should be used clinical practice to minimize likelihood of relapse. 5 × 5 Gy radiotherapy followed by immediate surgery allows good local control in resectable cT2N+/cT3N0 patients. Radical resection of isolated local recurrence offers the best chances of cure.

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