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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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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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. |
format | Online Article Text |
id | pubmed-7403872 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
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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