Successful management of lower rectal carcinoma recurrence on perineal pseudo-continent colostomy: A case report and review of literature

Recurrence of lower rectal carcinoma on perineal pseudo-continent colostomy is rarely reported in the literature. It presents a real challenge for the physician. The aim of this case report was to document an exceptional recurrence and how to manage it. A 56-year-old man presented with stage II adenocarcinoma of the lower rectum. He received concomitant chemoradiation followed by abdominoperineal resection with perineal pseudo-continent colostomy. Three years later, he developed a local recurrence of his prior adenocarcinoma, on the perineal pseudo-continent colostomy. He underwent wide excision, followed by reconstruction with a rectus abdominis myocutaneous flap with an inferior pedicle and an oblique skin paddle. He underwent adjuvant chemotherapy. The patient is free of disease with three years follow up. Extended resection should be considered as an initial treatment for locally recurrent rectal cancer.

Perineal psödo-kontinan kolostomi üzerinde alt rektal karsinom rekürrensinin başarılı tedavisi: Bir olgu sunumu ve literatürün gözden geçirilmesi

Perineal psödo-kontinan kolostomi üzerinde alt rektal karsinomun rekürrensi literatürde nadiren bildirilmektedir ve hekimler için gerçek bir zor durum oluşturmaktadır. Bu çalışmada, rektum kanserinde nadir bir rekürrens ve yönetimi sunulmuştur. 56 yaşında bir erkek hasta alt rektum yerleşimli evre II adenokarsinom ile başvurdu. Eş zamanlı kemoradyoterapi ve ardından perineal psödo-kontinan kolostomi ile abdominoperineal rezeksiyon yapıldı. Üç yıl sonra, perineal psödo-kontinan kolostomi üzerinde önceki adenokarsinomunun lokal rekürrensi gelişti. Hastaya geniş eksizyon uygulandı, ardından rektus abdominis miyokutan flebi ile inferior pedikül ve oblik cilt adasıyla rekonstrüksiyon yapıldı. Hasta adjuvan kemoterapi aldı. Hasta 3 yıllık takip süresinde hastalıksız olarak izlenmektedir. Kapsayıcı bir rezeksiyon, lokal rekürren rektum kanseri için ilk tedavi olarak düşünülmelidir.

Kaynakça

Schmidt E. The continent colostomy. World J Surg. 1982;6:805–9.

2. Yu TK, Bhosale PR, Crane CH, Iyer RB, Skibber JM, Rodriguez-Bigas MA, et al. Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer. Int J Radiat Oncol Biol Phys. 2008;71:1175–80.

3. Yun JA, Huh JW, Kim HC, Park YA, Cho YB, Yun SH, et al. Local recurrence after curative resection for rectal carcinoma: The role of surgical resection. Medicine (Baltimore). 2016;95:e3942.

4. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

5. Kusters M, Marijnen CA, van de Velde CJ, Rutten HJ, Lahaye MJ, Kim JH, et al. Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol. 2010;36:470–6.

6. Lasser P, Dubé P, Guillot JM, Elias D. Pseudocontinent perineal colostomy following abdominoperineal resection: technique and findings in 49 patients. Eur J Surg Oncol. 2001;27:49-53.

7. Souadka A, Majbar MA. Perineal colostomy may be the solution of phantom rectum syndrome following abdominoperineal resection for rectal cancer. J Wound Ostomy Continence Nurs. 2014;41:15–6.

8. Kuzu MA, Topcu O, Ucar K, Ulukent S, Unal E, Erverdi N, et al. Effect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in Muslim patients. Dis Colon Rectum. 2002;45:1359–66.

9. Souadka A, Majbar MA, El Harroudi T, Benkabbou A, Souadka A. Perineal pseudocontinent colostomy is safe and efficient technique for perineal reconstruction after abdominoperineal resection for rectal adenocarcinoma. BMC Surg. 2015;5:40.

10. Bosman SJ, Holman FA, Nieuwenhuijzen GA, Martijn H, Creemers GJ, Rutten HJ. Feasibility of reirradiation in the treatment of locally recurrent rectal cancer. Br J Surg. 2014;101:1280–9.

11. Dresen RC, Gosens MJ, Martijn H, Nieuwenhuijzen GA, Creemers GJ, Daniels-Gooszen AW, et al. Radical resection after IORT containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol. 2008;15:1937–47.

12. Heriot AG, Byrne CM, Lee P, Dobbs B, Tilney H, Solomon MJ, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum. 2008;51:284–91.

13. Rahbari NN, Ulrich AB, Bruckner T, Münter M, Nickles A, Contin P et al. Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? Ann Surg 2011;253:522–33.

14. Wiig JN, Poulsen JP, Larsen S, Braendengen M, Waehre H, Giercksky KE. Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer. Eur J Surg. 2002;168:42–8.

15. Lefèvre JH, Corte H, Tiret E, Boccara D, Chaouat M, Touboul E, et al. Abdomino-perineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence. Ann Surg Oncol. 2012;19:4186–92.

16. Ouar N, Mazouz-Dorval S, Revol M, Sorin T. Perineal reconstruction: the use of a gracilis muscle flap for urethral fistula coverage, our point of view. Ann Chir Plast Esthet. 2017;62:163–6.

17. Ferron G, Martel P, Querleu D. Vaginal reconstruction after pelvic exenteration: when and which techniques? Bull Cancer. 2003;90:435–40.

18. Leclère FM, Mordon S, Ramboaniaina S, Schoofs M. Breast reconstruction with a free DIEP flap complicated by spontaneous rupture of internal mammary artery. Ann Chir Plast Esthet. 2010;55:593–6.

19. Lahmidani S, Zakri B, Elotmany A. Pelvic reconstruction with a vertical rectus abdominis flap (VRAM): flap ischemia caused by a bladder globe. Ann Chir Plast Esthet. 2010;55:251–2.

Kaynak Göster