Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series.
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Issue Date
2020-07-16Keywords
External beam radiotherapyPROSTATE CANCER
Radiation proctitis
Rectal cancer
Rectal tumours
TAMIS
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International journal of surgery case reportsDOI
10.1016/j.ijscr.2020.07.039PubMed ID
32759040Abstract
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.Item Type
ArticleLanguage
enISSN
2210-2612ae974a485f413a2113503eed53cd6c53
10.1016/j.ijscr.2020.07.039
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