背景:盆腔放射治疗前列腺癌(PC)的后果可能对外科医生在直肠和乙状结肠肿瘤的管理方面构成重大挑战,导致广泛的纤维化和解剖困难。据报道,前切除术(AR)后输尿管损伤和吻合口漏的发生率更高,但对于最佳方法尚无明确共识。我们提出三个案例,每种方法都采用针对患者和疾病特异性因素的不同手术方法.
方法:在每种情况下,患者有活动性放射性直肠炎。病例1是距肛门边缘9厘米的T3直肠癌。进行了非恢复性手术,并进行了永久性的结肠末端造口术,由于共病患者中广泛的盆腔纤维化。在病例2中,使用经肛门微创手术(TAMIS)和覆盖环回肠造口术治疗了距肛门边缘12厘米处的大直肠息肉。在病例3中,患有恶性乙状结肠息肉的痴呆老年患者接受了节段性切除术,而不是标准的肿瘤切除术。因此在活动性放射性直肠炎的情况下避免了造口或直肠吻合。所有三名患者在随访中都保持良好,没有复发的证据。
结论:所有三个案例都显示出个性化的方法,考虑到与患者和疾病相关的特定因素。在所有情况下,活动性慢性放射性直肠炎的存在意味着原发性结直肠吻合术不安全,因此,采取了替代方法。
结论:根据患者特异性和疾病特异性因素定制治疗是至关重要的。
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: It is essential to tailor treatment according to patient-specific and disease-specific factors.