A novel in treatment of cancer anal canal

Abstract

Background: Posterior sagittal approach offers a direct exposure to the rectum, a better definition of the striated muscle complex, and a more objective way to reconstruct the arrangement between the neorectum and the muscle complex. Similar approaches have been used successfully for rectal and sigmoid resection for Hirschsprung’s disease and rectal cancer. The aim of this study was to assess the long term oncologic and functional results of a new technique of posterior sagittal approach for excision of anal canal and rectum and relocating the sigmoid colon into the tract of longitudinal striated muscle fibers in treatment of superficial cancer of anal canal. Method: 13 patients presenting with anal cancer were submit to posterior sagittal incision for resection of anal canal, rectum and mesorectum and relocation of the sigmoid colon within the anal sphincter. Results: This study included 8 males (61.5%) and 5 females (38.5%), their age ranged from 58 to 73 years (mean age 64.3 years) . Clinical examination and history showed bleeding in 6 patients (46.2%), straining during bowel motion in 5 patients (38.5%) and itching and change in bowel habits in 2 patients (15.4%). Trans-rectal ultrasound of 5 patients showed that the anal cancer was limit to the anal canal and the mass was 2 to 4 cm. (mean 2.9 cm.) and in 8 patients the mass was located at the anorectal junction, mostly carcinoma in the distal rectum infiltrating the anal canal, the size of the mass 3 to 5 cm. (mean 4.2 cm.). Histological examination: 8 patients (61.5%) diagnosed as adenocarcinoma were 4 males (30.8% and 4 females (30.4%) and 5 patients (38.5%) diagnosed as squamous cell carcinoma were 4 males (28.28%) and one female (7.7%). The mean operating time was 285 minutes ranging from 165 to 290 minutes. The longer operating time was usually at the first few cases at the beginning of the study. The mean length of resected part of the anal canal and rectum was 14.6 cm. ranging from 13 to 18 cm. The neorectum was well vascularized and its wall was kept uninjured during the procedure. There were no intra-operative or early postoperative complications, no patients had wound infection during the first 3 weeks, 4 patients had 6-11 bowel motions per day whereas the others had only 3 movements daily. Subsequently the frequency of bowel motions became normal in all patients within 4 months with 1 to 3 bowel motions per day. Follow-up for all patients must be at regular interval every 3 months for per-rectal examination and 6 months for transrectal ultrasound to detect any local recurrence. Two patients only had local recurrence at 34 and 30 months after surgery and were treated by abdominoperineal resection and permanent colostomy. Conclusion: The posterior sagittal approach seems to be a reliable method for resection of anal canal and rectum in treatment of superficial cancer of anal canal uT1 and uT2 provided that regular follow-up is adopted at 3 to 6-month intervals.