Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report

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 fistul...

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Autores principales: Inoue, Takuya, Sekido, Yuki, Ogino, Takayuki, Hata, Tsuyoshi, Miyoshi, Norikatsu, Takahashi, Hidekazu, Uemura, Mamoru, Mizushima, Tsunekazu, Doki, Yuichiro, Eguchi, Hidetoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645675/
https://www.ncbi.nlm.nih.gov/pubmed/37962718
http://dx.doi.org/10.1186/s40792-023-01778-6
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author Inoue, Takuya
Sekido, Yuki
Ogino, Takayuki
Hata, Tsuyoshi
Miyoshi, Norikatsu
Takahashi, Hidekazu
Uemura, Mamoru
Mizushima, Tsunekazu
Doki, Yuichiro
Eguchi, Hidetoshi
author_facet Inoue, Takuya
Sekido, Yuki
Ogino, Takayuki
Hata, Tsuyoshi
Miyoshi, Norikatsu
Takahashi, Hidekazu
Uemura, Mamoru
Mizushima, Tsunekazu
Doki, Yuichiro
Eguchi, Hidetoshi
author_sort Inoue, Takuya
collection PubMed
description 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.
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spelling pubmed-106456752023-11-14 Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report Inoue, Takuya Sekido, Yuki Ogino, Takayuki Hata, Tsuyoshi Miyoshi, Norikatsu Takahashi, Hidekazu Uemura, Mamoru Mizushima, Tsunekazu Doki, Yuichiro Eguchi, Hidetoshi Surg Case Rep Case Report 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. Springer Berlin Heidelberg 2023-11-14 /pmc/articles/PMC10645675/ /pubmed/37962718 http://dx.doi.org/10.1186/s40792-023-01778-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Inoue, Takuya
Sekido, Yuki
Ogino, Takayuki
Hata, Tsuyoshi
Miyoshi, Norikatsu
Takahashi, Hidekazu
Uemura, Mamoru
Mizushima, Tsunekazu
Doki, Yuichiro
Eguchi, Hidetoshi
Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report
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 Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645675/
https://www.ncbi.nlm.nih.gov/pubmed/37962718
http://dx.doi.org/10.1186/s40792-023-01778-6
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