Perineal Resection Research Articles

Anorectal malignant melanoma with multiple organ metastases

Abstract Introduction: Anal malignant melanoma (ARMM) is a fatal malignancy with high malignant potential and poor patient prognosis. The ARMM incidence account for 0.4% to 1.6% of all malignant melanomas (MM), and 37% of patients already have distant or local metastases during the initial diagnosis. However, the low ARMM incidence and the lack of definitive studies have led to a very high rate of misdiagnosis and missed diagnosis. This case report describes brain metastasis and liver metastasis in ARMM patient. Patient Concerns: The patient, a 49-year-old Chinese male, was admitted to the hospital because of altered defecation habits for four years, hematochezia, and difficult defecation for 2 months. Diagnoses: Rectal palpation found a mass 2 cm from the anus. Colonoscopy revealed an infiltrative growing mass 2 cm from the anus. Pathological results confirmed MM. The diagnosis was Rectal MM with incomplete intestinal obstruction. Interventions: The patient underwent laparoscopic assisted combined abdominal perineal resection under general anesthesia. Outcomes: On the second day after surgery, the patient developed sensory impairment and motor dysfunction in the right upper extremity. Cranial computed tomography and magnetic resonance imaging suggested multiple occupying lesions in the brain. On the eighth postoperative day, the patient's condition deteriorated. The patient died after a one-month follow-up. Conclusions: This study describes a ARMM patient with brain and liver metastases that was diagnosed late. Pathology combined with immunohistochemistry is important to diagnose ARMM and proper auxiliary examinations can help in early diagnosis.

Proteinemia as a Prognostic Factor in Colorectal Cancers beyond Surgery and Chemotherapy

Abstract Background Globally, 1,096,601, 704,376, and 48,541 new colon, rectum, and anus cancer cases were recorded in 2018, respectively. Besides, 551,269, 310,394 and 19,129 cases of colon, rectum, and anus cancer deaths occurred in the same year. As a result, these cancers ranked in the third level of cancer incidence, and in the second level of cancer mortality. As it is known, all cancer patients are subjected to cancer-induced and therapy-induced nutritional deficiencies (mainly of proteins and calories). The present study aimed to assess proteins level in colorectal cancer (CRC) patients who underwent surgery and chemotherapy. Methods A combined retrospective and prospective study was performed. The present study enrolled 100 CRC patients with their data on surgical procedures and chemotherapy management. Assessments of the studied samples were conducted as a baseline before receiving chemotherapy and preoperatively as P0, while the period after that was termed as P1. The serum samples were collected to measure protein concentration. Total Protein Kit, Micro was used. Results The mean age of the patients was 50.7 ± 12.88 years old. Only 8% had a positive CRC family history. Rectosigmoid cancer represented the most frequent site, figured in 41% of the cases, followed by rectum cancer. Multiple sites of CRC metastasis were recorded in 15% of the patients. All patients received chemoradiation. Folinic acid (leucovorin), 5-FU, and oxaliplatin (FOLFOX) was the most used regimen, administered in 40% of the patients. Oxaliplatin and capecitabine (also called Xeloda) (XELOX) were administered in 14% of the patients. Folinic acid (leucovorin), 5-FU, oxaliplatin, and irinotecan (FOLFOXIRI) were administered in 16% of the patients. Single-agent oxaliplatin or carboplatin were administered in 6% of the patients, each. 5-FU plus leucovorin was administered to12% of the patients. Three patients received irinotecan, and oxaliplatin (IROX). One patient received folinic acid (leucovorin), 5-FU and irinotecan (FOLFIRI). Also, Gemzar was administered to two patients only. A total of 80% of the patients underwent several surgical procedures. Anterior perineal resection (APR) and total mesorectal excision (TME) were the most common two surgeries, performed in 20 and in 30% of the patients, respectively. In P0 status, 44% of the patients suffered from low protein levels, and 13% of the patients were within the normal level. These findings were statistically different (p = 0.03). After CRC management (i.e., P1 status), 70% of the patients had protein deficiency. These results have strong significant differences (p = 0.000). The mean of protein concentration declined gradually after management, from 8.82 ± 0.9 μg/L to 6.21 ± 0.78 μg/L, with a strong association between a reduction in proteins levels towards deficiency and surgical procedures and chemotherapy protocols (p = 0.000). Conclusion The incidence of CRC is increasing annually, and the chance of being diagnosed with this type of cancer has risen in recent years. In the present study, the male to female ratio was 1:1.5, and the 5th decade of life was the most common age for the diagnosis of CRC. A negative family history and bowel inflammatory diseases (IBD) history did not exclude people from exposure to the incidence of CRC. Colorectal cancer with localized and moderately differentiated adenocarcinoma were the most common types in the present work. Tumor distance from the anal verge seems to be very important and plays a significant role in the choosing of surgical intervention types and chemoradiation protocols. Colorectal cancer acts as a complex condition and, in addition to its management, nutritional state influences it in different mechanisms. Most patients suffered from hypoproteinemia after surgery and chemoradiation. As a result, alteration in the treatment outcomes, delaying in wound healing, and an increase in postoperative complications may occur.

Intensified Induction Chemotherapy in Locally Advanced Squamous Cell Carcinoma of the Anus-A Population-Based Experience from the Danish Anal Cancer Group.

Simple SummaryThe primary treatment modality for anal cancer is chemoradiotherapy, but patients with locally advanced disease (i.e., large tumors and/or involvement of regional lymph nodes) have a high risk of treatment failure. The use of chemotherapy prior to radiotherapy (induction chemotherapy) can potentially shrink the tumor and/or eradicate small cancer cells with metastatic potential, with a chance of a better outcome. With this paper, the authors present 20 years of nationwide experience with intensified induction chemotherapy in the treatment of locally advanced anal cancer, which indicates a role for further investigation in the most advanced cases.Locally advanced squamous cell carcinoma of the anus (LASCCA) has a poor prognosis with a high risk of treatment failure calling for intensified therapy. We present the long-term follow-up of a nationwide cohort of LASCCA treated with intensified induction chemotherapy (ICT). The study included patients with LASCCA (T3-4N0 or T1-4N+) treated with at least one cycle of ICT (cisplatin, ifosfamide, leucoverin, and 5-flourouracil) between 1998–2018. Data were retrospectively collected from medical records, and statistics were performed in STATA 16.1. In total, 166 patients with LASCCA were identified. Following ICT, 157 patients (95%) received primary curative treatment with either radiotherapy (70%), chemoradiotherapy (27%), or abdominal perineal resection (3%). The overall local tumor response rate after ICT was 76% with 20 (13%) achieving complete local tumor response. After the primary treatment, 123 patients (79%) obtained complete response, and 27 underwent salvage surgery due to persistent disease. The median follow-up time was 6 years, local and distant failure rates 22% and 13%, respectively. The 3- and 5-year disease-free survival rates were 70% and 67%, and the 3- and 5-year overall survival rates were 76% and 70%, respectively. Intensified ICT regimen could be a supplementary treatment option in the most advanced cases of LASCCA. Prospective randomized trials are needed to investigate this approach further.

Obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran: a retrospective, case-control study

BackgroundThe purpose of the present study was to evaluate obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran.ResultsA case-control study was conducted on 55 COVID-19 as the case and 55 matched control pregnant women in Hormozgan, Iran. Patients were considered to be cases if they had a positive COVID-19 test plus a positive chest X-ray result. Our measures were COVID-19 symptoms, including laboratory evaluations, clinical symptoms, and maternal and neonatal outcomes.The most prevalent symptoms related to COVID-19 were fever (69.09%) and cough (58.18%). Less common symptoms included fatigue, diarrhea, shortness of breath, sore throat, and myalgia. Hydroxychloroquine/chloroquine (58.18%) and antibiotic therapy (45.45%) were the most prevalent management in COVID-19 patients. Based on our findings, maternal and obstetric outcomes—neonatal in case groups—such as mode of delivery, premature rupture of membrane, postpartum hemorrhage, perineal resection rate, neonates’ birth weight, Apgar score, and neonatal asphyxia rate were similar to pregnant women without COVID-19. We observed a higher incidence rate of premature delivery in COVID-19 cases (25 vs. 10%) (p < 0.05). In the present study, we found that women with COVID-19 had a more than twofold increased odds of preterm labor. History of preterm delivery was also associated with high twofold odds of preterm labor.ConclusionWe observed a higher incidence rate of premature delivery in COVID-19 cases. Women with COVID-19 had a more than twofold increased odds of preterm labor. Considering prematurity has high morbidity and is regarded as the primary cause of mortality in children under 5 years old, more case-control studies are needed to ascertain the results.

59 The use of sacral nerve stimulation in patients with rectal prolapse

Rectal prolapse is a common disorder that can afflict up to 1% of all adults over the age of 65. Once a prolapse has occurred, 50-75% also complain of fecal incontinence from various causes. Some patient’s fecal incontinence resolved after 6 months from surgical repair but for those with long term prolapse, fecal incontinence persist and does not improved. Sacral nerve stimulator (SNS) has long been placed initially for urinary incontinence in 1988 and subsequently for fecal incontinence since 1995, with good success. With the high incidence of fecal incontinence associated with rectal prolapse, we evaluate the placement of SNS for patient with complaint of rectal prolapse prior to their surgical repair, to assess if improving sphincter tone and continence will improve their prolapse and spare them from a surgical pexy and or resection. a prospective study of patients who presented with rectal prolapse was assessed with physical exam, documentation of prolapse, Wexner incontinence score as well as anal manometry. Patient was then offered SNS prior to their surgical repair. If SNS fails, surgical repair includes laparoscopic/robotic rectopexy, laparoscopic/robotic rectopexy with low anterior resection, and Altmeiyer repair. SNS were placed in a single stage and assessed at 1 month, 3 months, 6 month and a year then yearly with history and physical exam as well as anal manometry. If there was no improvement, the patient would then undergo a surgical repair. 28 patients (female median age 79) underwent placement of SNS after presenting with rectal prolapse. Of these, 9 of 28 (30%) patients achieved treatment improvement at 6 months & success without daily prolapse after an average of 21 months. One of the 28 had a perineal resection a month prior by another colorectal surgeon and proceeded to prolapse 36 days later. The other 18 patients went on for abdominal or perineal repair based on medical problems and patient preference. 15 patients had Altmeiyer, 2 laparoscopic resections with rectopexy and 1 laparoscopic rectopexy alone. The median follow-up of 29 months (range 2-52). Of the 9 patients who did not undergo repair, one had 2 episodes of prolapse with a bout of severe constipation but improved and yet to have surgical intervention. None of the devices needed to be explanted. SNS can be effective for those with rectal prolapse whose prolapse is less than 3cm in length. It provides a less invasive options for patients improving their fecal incontinence and prolapse without a more invasive surgery. Unfortunately, this was only successful in 9 patients with short segment prolapse. The numbers are too low at this time without a larger trial. Currently, it cannot replace neither abdominal or perineal resection but does offer an option to both treat fecal incontinence as well as rectal prolapse. Despite the low numbers, SNS can be considered before undertaking resection for short segment rectal prolapse.

Retrospective cohort of total neoadjuvant therapy (TNT) in high-risk locally advanced rectal cancer (HR-LARC): Additional sintilimab (PD-1) in tri-modality approach.

e15604 Background: TNT is an emerging practice adapted to ensure all patients (pts) receive of systemic therapy, particularly for pts with high risk recurrence. Our previous phase II trial of TNT in MRI stratified HR-LARC demonstrated high down-staging rate and improved complete response with acceptable toxicity (manuscript under review). The aim of this retrospective cohort study was to evaluate the feasibility of sintilimab in combination with chemotherapy in TNT tri-modality treatment of pts with HR-LARC. Methods: HR-LARC pts who were given 3 cycles of sintilimab (200mg, iv, q3w) in combination with CapeOx followed by sequential long-course radiotherapy (IMRT GTV50.6 Gy/CTV 41.8 Gy/22f), 2 cycles CapeOx and surgery were enrolled from Beijing Cancer Hospital, CHN. The high risk was defined as middle to low RC (≤8cm to ARJ or 12 cm per sigmoidoscopy) with ≥1 factor from MRI features: clinical stage T3c/d-T4a/b, or N2 or MRF (+) or EMVI (+). The clinical outcomes included pathological response, major response rate (cCR+MPR), R0 resection rate, and toxicity. Results: From Feb 2019 to Oct 2020, 19 cases were identified with median distal location 4 cm (3-7), T2/T3/T4 1/15/3, N1/N2a/N2b 7/4/8, MRF+ 8/11, EMVI+ 8/11. Other characteristics were pMMR/MSS 100%, age 67y (47-78), male 57.9%, PS 1 100%, c-stage III 100% (18), median diameter of primary lesion 5.1 cm (2.1-7.5). As of 30th Dec 2020, 84.2% (16/19) received neoadjuvant therapy and completed surgical resection, with R0 resection rate 100%. One pts denied surgery and two chose watch &amp; wait since achieving cCR 10.5% (2/19). Of 16 resection pts, 13 had sphincter-sparing surgery (LAR or TaTME). One had Hartmann procedure, and two had abdominal perineal resection. The sphincter preservation rate was 84.2% (16/19). The pCR was 26.3% (5/19), and MPR was 47.3% (9/13). The major response rate was 57.9% (11/19), 4/2/13 of which completed intact TNT schema, induction and RT, and induction phase only, respectively. Treatment related adverse events (TRAE) occurred in 6 pts (31.6%) in grade (gr) 1-2 (CTCAE 5.0) without any gr 3-5 events occurred. Immune-related AEs were found in 2 pts with hypothyroidism (gr 1,2). Postoperative complications included two gr2 (Clavien-Dindo) events of anastomtic bleeding and infection. Of note, 3 pts with anastomotic stenosis got stoma reversion after dilation. Conclusions: Given the impressive response rate (57.9%), this retrospective analysis suggested a potential enhanced anti-cancer activity and good tolerability in pMMR/MSS HR-LARC from sintilimab in combination with TNT. The encouraging results warrant further evaluation of this approach in prospective trial.

Abdomino Perineal Resection

Abdomino Perineal Resection

A clinical and molecular portrait of non-metastatic anal squamous cell carcinoma

Anal squamous cell carcinoma (ASCC) is a rare gastrointestinal malignancy associated with high-risk Human papillomavirus (HPV) infection. Despite improved outcomes in non-metastatic ASCC, definitive chemoradiotherapy constitutes the standard treatment for localized disease. Evidences for predictive and prognostic biomarkers are limited. Here, we performed a viral, immune, and mutational characterization of 79 non-metastatic ASCC patients with complete definitive chemoradiotherapy. HPV-16 was detected in 91% of positive cases in single infections (78%) or in coinfections with multiple genotypes (22%). Fifty-four percent of non-metastatic ASCC cases displayed mutations affecting cancer driver genes such as PIK3CA (21% of cases), TP53 (15%), FBXW7 (9%), and APC (6%). PD-L1 expression was detected in 57% of non-metastatic ASCC. Increased PD-L1 positive cases (67%) were detected in patients with complete response compared with non-complete response to treatment (37%) (p = 0.021). Furthermore, patients with PD-L1 positive tumors were significantly associated with better disease-free survival (DFS) and overall survival (OS) compared with patients with PD-L1 negative tumors (p = 0.006 and p = 0.002, respectively). PD-L1 expression strongly impacts CR rate and survival of non-metastatic ASCC patients after standard definitive chemoradiotherapy. PD-L1 expression could be used to stratify good versus poor responders avoiding the associated morbidity with abdominal perineal resection.

Safety and efficacy of preoperative mFOLFOX6 regimen chemotherapy for locally resectable advanced rectal cancer.

Neoadjuvant chemotherapy combined with radical surgery has become the treatment model for locally advanced rectal cancer. The purpose of this study was to evaluate the safety and efficacy of postoperative mFOLFOX6 regimen chemotherapy for locally resectable advanced rectal cancer. This was a prospective study. A total of 82 patients with locally advanced rectal cancer admitted to Affiliated Nanhua Hospital, University of South China from February 2015 to December 2017 were selected as the subjects. The patients received 4 courses of mFOLFOX6 chemotherapy and underwent surgery within 4-6 weeks after chemotherapy. The incidences of chemotherapy-related adverse reactions, postoperative complications, and clinical pathological reactions were analyzed. In the period from mFOLFOX6 chemotherapy to preoperative, 82 patients with locally advanced rectal cancer was reported chemotherapy-related adverse reactions, including Grade 4 neutropenia (2.4%), catheter related infection (2.4%), and anorexia (2.4%), Grade 3 nausea (2.4%) and anorexia (2.4%), Grade 2 neutropenia (14.6%) and peripheral neuropathy (7.3%). Finally, 76 patients with locally advanced rectal cancer completed surgery, including 56 (73.7%) with anterior rectum resection, 16 (21.1%) with abdominal perineal resection, and 72 (94.7%) with pelvic nerve preservation. A total of 22 (28.9%) patients had surgical complications, including 8 (10.5%) with complications of Grade 3 or above. The complications with high incidence were intestinal obstruction, anastomotic leakage, and sepsis. Among the 76 patients who completed chemotherapy and surgery, T stage was decreased in 28 (36.8%) and N stage was decreased in 44 (57.9%); forty-two (55.3%) were in pathological Stage I, 20 (26.3%) in Stage IIA, 12 (15.8%) in Stage IIB, and 2 (2.6%) in Stage IIIA. Ten patients were suspected of tumor invasion of surrounding organs before chemotherapy, of which 4 patients did not need to extend the resection of surrounding organs after chemotherapy and achieved R0 resection of tumor; 2 in T4b stage before chemotherapy received extended resection of surrounding organs, and the postoperative pathological result was T3, and achieved R0 resection; 1 diagnosed as poorly differentiated adenocarcinoma with seminal vesicle invasion in the evaluation before chemotherapy had T-stage progression after operation. There were 66 (86.8%) patients of partial response (PR), 9 (11.8%) of stable disease (SD) and 1 (1.3%) of progressive disease (PD). There was no complete response (CR) and no new lesion. Preoperative mFOLFOX6 regimen chemotherapy for locally resectable advanced rectal cancer is a safe and feasible treatment strategy, and it is worthy of clinical application.

Laparoscopic abdominal perineal rectal resection for rectal cancer with a horseshoe kidney using preoperative 3D-CT angiography: a case report

BackgroundA horseshoe kidney is a congenital malformation involving the fusion of the bilateral kidneys and is often accompanied by anomalies of the ureteropelvic and vascular systems. When performing resection of colorectal cancer in a patient with horseshoe kidney, damage to the ureter or excessive renal arteries should be avoided. To achieve this purpose, comprehensive preoperative anatomical assessments and surgical planning are important. Here, we report a case of a laparoscopic abdominal perineal rectal resection for lower rectal cancer with a horseshoe kidney.Case presentationA 79-year-old woman presented with bloody stool and was diagnosed with advanced lower rectal cancer, immediately above the rectal dentate line, without metastasis. A preoperative computed tomography (CT) scan revealed a horseshoe kidney, while a three-dimensional CT (3D-CT) angiography revealed aberrant excess renal artery from the aorta to the renal isthmus. The left ureter ran in front of the isthmus of the horseshoe kidney and presented calculus formation. Laparoscopic abdominal perineal rectal resection was performed with D3 lymph node dissection. During the operation, we mobilized the sigmoid colon mesentery via a medial approach and preserved the left ureter, the left gonadal vessels, and the hypogastric nerve plexus in the retroperitoneum in front of the horseshoe kidney.ConclusionsWe report a rare case of rectal cancer surgery in a patient with a horseshoe kidney. We discuss the anatomical peculiarities of a horseshoe kidney, such as excess renal arteries, inferior vena cava, ureter, gonadal vessels, and nerves, that should be preserved according to the literature. We suggest that preoperative 3D-CT angiography is both useful for revealing the relationship between the vascular system and a horseshoe kidney and helpful when performing laparoscopic surgery for a left-sided colon and rectal cancer to avoid intraoperative injury.

Ultra-Low Hartmann’s Versus Intersphincteric Abdominal Perineal Resection in Distal Rectal Cancers- A Single Centre Review

Introduction: Patients with distal rectal cancer with predicted poor functional outcome for primary anastomosis, there are two proposed non-restorative surgical management include Ultra Low Hartmann’s (ULH) and Intersphincteric abdominal perineal resection (IAPR). The aim of this study is to compare short term postoperative morbidity and mortality between the two groups. Methods: Patients who either had a ULH or an IAPR between 2013-2019 in a single centre were included in this retrospective cohort study. Follow-up for 30 days was performed and data was collected and analysed. Results: A total of 54 patients were included in the study, 14 in the ULH group and 40 in the IAPR group. There was no difference in age between the groups however the ULH had more patients with comorbidities and higher ASA scores compared to the IAPR group. ULH resulted in more severe complications 14% compared to IAPR with 2.5% (p=0.18). three out of 14 patients (21%) in the ULH group develop a pelvic collection compared to one out of 40 (2.5%) in the IAPR group (p=0.01). Reintervention were performed in 2 patients in the ULH group (14%) compared to 5 patients in the IAPR group (12.5%) p=0.24. The readmission rate was 14% in the ULH group and 27.5% in the IAPR group (p=0.73). Conclusion: The results from the study suggest that IAPR can be considered an alternative to ULH in patients with low rectal cancer given that ULH was associated with a higher rate of pelvic abscesses and reoperation.

Tạo hình khuyết hổng trong phẫu thuật ung thư âm hộ: báo cáo 2 trường hợp tạo hình phức tạp và tổng quan y văn

Performing radical surgery for locally advanced vulvar cancer is usually associated with the occurrence of large perineal defects. These defects, especially in previously radiated cases, often require more advanced reconstructive techniques using locoregional flaps. We present two cases of vulvar reconstruction, one case using a split and thinned, transversely oriented, pedicled deep inferior epigastric artery perforator (DIEP) flap and another one with gracilis myocutaneous flap. These pedicled flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for locally advanced vulvar cancers. especially in pre-irradiated patients.

Salvage surgery for locally recurrent anal cancer after intensity modulated radiation therapy with concurrent chemotherapy

IntroductionChemoradiation (CRT) with intensity modulated radiation treatment (IMRT) has become the standard for anal cancer. In patients who fail this treatment modality, salvage surgery with abdominal perineal resection can result in long term cancer control. We aimed to evaluate a single centre's experience of salvage surgery for local recurrence since the introduction of IMRT. Materials and methodsA retrospective chart review was performed of all patients who underwent definitive CRT for anal carcinoma at a single tertiary referral center since IMRT became standard in 2009. Patients with recurrent or persistent disease after treatment who underwent salvage surgery were included. Details of CRT, salvage surgery and surgical complications, patterns of recurrence after surgery, and survival data were collected and described. ResultsBetween 2009–2018, 181 patients underwent definitive treatment using IMRT for anal carcinoma. Of 26 patients who had locoregional recurrent or persistent disease, 14 underwent salvage surgery. Nine had multi-visceral resection and 8 required autologous flap reconstruction. Twelve patients had resections with clear margins and 2 had microscopic positive margins. Twelve patients (86%) experienced post-operative complications, and eight (57%) had perineal wound complications. After salvage, four patients (29%) recurred locally. None of the 8 patients with rpT2 disease recurred. After salvage surgery, 5-year disease free survival was 68.4% and 5-year overall survival was 75%. ConclusionFollowing IMRT based chemoradiation, salvage surgery has high rates of surgical complications; however disease free and overall survival results are excellent particularly for small recurrences.

Incisional negative pressure wound therapy to reduce perineal wound infection after abdominoperineal resection.

We explored the effects of incisional negative pressure wound therapy in perineal wound infections after abdominoperineal resection. We retrospectively evaluated 146 patients who underwent abdominal perineal resection from December 2004 to December 2019 and compared conventional gauze dressing (controls) with incisional negative pressure wound therapy. We compared patients' characteristics, surgical factors, and perineal infection rates between groups, and patients' characteristics, surgical factors, and negative pressure therapy use between perineal infection vs non‐infection groups, as well as the risk factors for perineal infections. In the negative pressure therapy group, compared with controls, the number of men, smoking prevalence, blood transfusion, drainage via the perineal wound, and intraoperative blood loss were significantly lower (p < 0.05, p < 0.05, p < 0.05, p < 0.001, p < 0.01, respectively), and operation time was significantly longer (p < 0.05). Infections were significantly less common in the negative pressure group (p < 0.05). In the univariate analysis, the infection‐positive group had significantly higher laparoscopic surgery (p < 0.01) and negative pressure wound therapy‐free rates (p < 0.01), and significantly more intraoperative blood loss (p < 0.05). Multivariate analysis using these three factors and preoperative radiotherapy showed that incisional negative pressure wound therapy‐free status was a risk factor for infection. Incisional negative pressure wound therapy was beneficial in managing perineal wound infections after abdominoperineal resection.

Total Pelvic Exenteration with Genitalia Resection and Extensive Perineal Skin Tissue Resection for Locally Advanced Anal Fistula Cancer: A Case Report

Total Pelvic Exenteration with Genitalia Resection and Extensive Perineal Skin Tissue Resection for Locally Advanced Anal Fistula Cancer: A Case Report

Abdominal perineal resection surgery: case report

Colorectal cancer in known to be the most diagnosed cancer in the world, the set gold standard for the treatment of colorectal cancer is excision of the tumor via surgery. There is different type of surgeries that tend to be performed depending on the location, size and extent of the mass in order to avoid recurrence. The main aim of this paper is to discuss the abdominal perineal resection surgery together with the complications faced and criteria in managing these complications intraoperatively.

The safety and efficacy of radical surgery after modified total neoadjuvant therapy for locally advanced rectal cancer

Objective: To analyze the clinical-pathological data of patients with locally advanced rectal cancer who underwent modified total neoadjuvant therapy (TNT), and to evaluate the safety and efficacy of radical surgery after modified total neoadjuvant therapy. Methods: The clinical-pathological data of 30 locally advanced rectal cancer patients who underwent modified TNT (mTNT) followed by radical resection were retrospectively analyzed. The surgical procedure, postoperative complications, tumor regression grade, tumor downstaging and prognosis were analyzed. Results: The 30 patients included 24 males and 6 females with a median age of 55.5 years. All patients underwent radical surgery after neoadjuvant therapy, 14 patients received low anterior resection, 14 patients received abdominal perineal resection, and the other 2 patients received Hartmann procedure. All patients achieved R0 resection with a median operative time 220 minutes and the median intraoperative blood loss was 200 ml. The morbidity of postoperative complications was 20% (6/30), including dysuria in 2 patients, delayed healing of perineal incision in 2 patients, intestinal obstruction in 1 patient and pelvic hemorrhage in 1 patient. The median time to first flatus after surgery was 3 days and the median postoperative hospital stay was 8 days. Postoperative pathological results showed that 15 patients (50.0%) had severe tumor regression, including 4 patients (13.3%) achieved pathological complete response (pCR), 12 patients (40.0%) had moderate tumor regression, and 3 patients (10.0%) had minor tumor regression. Twenty patients had detailed pre-treatment clinical stage, and among those 20 patients, 15 patients (75.0%) and 13 patients (65.0%) achieved downstaging of tumor T stage and N stage, respectively. Only 2 patients appeared distant metastasis, and no patient had local recurrence. Conclusions: For locally advanced rectal cancer patients, mTNT doesn't increase the morbidity of postoperative complication and is a safe and effective treatment strategy with satisfactory short-term result.

Perineal resection and anorectal amputation with perforator flap reconstruction by a dorsal approach in prone Jackknife position

Some gynecological malignancies, such as vulvar or vaginal cancer, can present a local extension to the anus or rectum due to their close anatomical relationship. The frontline treatment in the...

Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic.

ObjectiveTo study vaginal delivery outcomes and neonatal prognosis and summarize the management of vaginal delivery during the COVID‐19 pandemic.MethodsA retrospective analysis of medical records and comparison of vaginal delivery outcomes between 10 pregnant women with clinical diagnosis of COVID‐19 and 53 pregnant women without COVID‐19 admitted to Zhongnan Hospital of Wuhan University between January 20 and March 2, 2020. Results of laboratory tests, imaging tests, and SARS‐CoV‐2 nucleic acid tests were also analyzed in neonates delivered by pregnant women with clinical diagnosis of COVID‐19.ResultsThere were no significant differences in gestational age, postpartum hemorrhage, and perineal resection rates between the two groups. There were no significant differences in birth weight of neonates and neonatal asphyxia rates between the two groups. Neonates delivered by pregnant women with clinical diagnosis of COVID‐19 tested negative for SARS‐CoV‐2 infection.ConclusionsUnder the premise of full evaluation of vaginal delivery conditions and strict protection measures, pregnant women with ordinary type COVID‐19 can try vaginal delivery without exacerbation of COVID‐19 and without increasing the risk of SARS‐CoV‐2 infection in neonates.

Transanal Total Mesorectal Excision.

The ability to effectively manage patients with rectal cancer is perhaps the defining characteristic of colon and rectal surgeons. From a historical perspective, the first attempts at resection of the rectum were reported in the early 1800s by Lisfranc.[1] Kocher described the removal of the coccyx and Kraske popularized this perineal approach. The first abdominal attempts at rectal resection were performed at the turn of the 20th century.[2] Modifications to the abdominal perineal resection were reported into the 1920s. The introduction of the circular stapler in the 1970s changed the face of rectal cancer surgery and facilitated lower anastomoses.[3] This technical revolution greatly facilitated sphincter preservation. However, oncologic success in the management of rectal cancer lagged behind the avoidance of stomas. It was not until the importance of the mesorectum was understood that pelvic recurrence was significantly reduced. The “holy plane” of rectal surgery was described in 1988 by Heald[4]; soon thereafter the importance of tumor-free circumferential margins was realized. The understanding of the importance of the total mesorectal excision (TME) for oncologic success grew and became the standard approach for the treatment of rectal cancer. It has been 30 years since the concepts of TME and tumor-free circumferential resection margins were introduced. These three decades have brought many technological surgical advances enhancing our ability to accomplish the task with less invasive measures. However, there have been no changes to the technique of TME other than the size of the incision created. The introduction of the transanal TME (taTME) in 2010[5] was the first innovation in the technique of TME in the past 25 years. Facilitated by advances in instrumentation, the transanal approach grew from an access point for local excision to one, which offered surgeons the ability to perform a complete oncologic resection of the rectum. This method gives surgeons a totally new perspective to the lower third of the pelvis, which has historically been the most challenging portion of the TME from the traditional approach. TaTME requires a thorough understanding of the planes and pelvic anatomy from a new vantage point. Mastery of this novel approach to the treatment of rectal cancer offers patients a minimally invasive resection with potentially better visualization and therefore a better quality of the resected specimen. This volume is a compilation of informative references from many of the pioneers of the technique of taTME. This issue provides the reader with a thorough summary of the anatomical basis for TME and the development of transanal surgical techniques. With a comprehensive understanding of the anatomic principles of rectal cancer surgery and the technologic advances in transanal surgery, one can then make the transition to the new “down to up” taTME approach to rectal cancer treatment. The evolution of the technique is presented followed by detailed step-by-step instructions. After a comprehensive review of the results and potential complications of taTME, the final sections will guide the reader through the process of learning taTME with standardized platforms and tips for safe and successful adaption of the technique. This Clinics in Colon and Rectal Surgery issue will conclude with a look to the future and the potential for the approach of taTME to facilitate extended resections with technological advances. It is with a debt of gratitude and sincere thanks to the contributing authors that the editors offer this collection of thoughtful works prepared by the pioneers of taTME.