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Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series

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 anteri...

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Autores principales: Hannan, Enda, Ryan, Jessica, Toomey, Desmond
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403872/
https://www.ncbi.nlm.nih.gov/pubmed/32759040
http://dx.doi.org/10.1016/j.ijscr.2020.07.039
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author Hannan, Enda
Ryan, Jessica
Toomey, Desmond
author_facet Hannan, Enda
Ryan, Jessica
Toomey, Desmond
author_sort Hannan, Enda
collection PubMed
description 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.
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spelling pubmed-74038722020-08-07 Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series Hannan, Enda Ryan, Jessica Toomey, Desmond Int J Surg Case Rep Article 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. Elsevier 2020-07-16 /pmc/articles/PMC7403872/ /pubmed/32759040 http://dx.doi.org/10.1016/j.ijscr.2020.07.039 Text en © 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Hannan, Enda
Ryan, Jessica
Toomey, Desmond
Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
title Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
title_full Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
title_fullStr Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
title_full_unstemmed Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
title_short Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series
title_sort technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403872/
https://www.ncbi.nlm.nih.gov/pubmed/32759040
http://dx.doi.org/10.1016/j.ijscr.2020.07.039
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