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Pelvic exenteration and pelvic reconstrution with myocutaneous gluteal fold flap
Apresentação do caso
FSS, male, 58 years old. Patient with no reported comorbidities was admitted in the oncology surgery service on 05/15/19 with chronic proctalgia, bleeding and weight loss of 16Kg in 2 years. The initial colonoscopy findings included an large obliterating rectal lesion with neoplasm appearance involving the rectum and anal canal, which histopathological was compatible with adenocarcinoma. Physical examination: ECOG 1, absence of lymph nodes enlargement, and abdomen with no abnormalities . Rectal examination: obliterating rectal tumor, fixed to deep planes, affecting 2/3 of the anal canal and low rectum, with partial involvement of the gluteus on the right. CT scans: unaltered chest and upper abdomen, pelvis with large tumor obliterating, involvement of the prostate and posterior bladder wall, preservation of the lateral pelvic walls. Submitted to colostomy and neoadjuvant chemoradiotherapy. After neoadjuvant therapy, CT scans findings showed partial tumor response. He underwent total pelvic exenteration with amputation of the rectum, excision of the gluteal muscle segment on the right, bricker and myocutaneous flap, without complications. Histopathological findings of adenocarcinoma tubular infiltrative with diffuse fibrosis, free surgical margins, perivesicular tissue and right pelvic wall infiltrated with predominance of necrosis, lymph nodes 0/18, ypT4bN1cMx, EC IIIC. He underwent adjuvant chemotherapy and are being followed up for 22 months with no evidence of disease.
Prospective and retrospective studies show that pelvic exenteration (PE) for advanced rectal cancer has high morbidity, but complete resections (R0) have good local control and overall survival (OS) . In 5 years, local control can be greater than 80% and OS greater than 60% . Complication rates of 50% and perioperative mortality of 2% are observed [2, 3]. The surgical technique has achieved great advances. PE can be performed safely and with potential benefits for high-selected cases, considering the complexity of the case, tumor biology, multidisciplinary resources, surgeon experience and for correction of perineal defect, the gluteal fold flap is very useful and safe [4-6].
PE surgery for advanced rectal cancer is technically challenging, but increasingly performed in specialized centers by experienced surgeons. The survival results are favorable, which makes the risk acceptable in the absence of other treatment modalities.
Pelvic exenteration (PE); rectal cancer; Pelvic reconstruction
Tumores coloretais e canal anal*
VITOR AUGUSTO MELÃO MARTINHO, RENATO MORATO ZANATTO, KARLA THAIZA TOMAL, CELSO ROBERTO PASSERI, EDUARDO MARCUCCI PRACUCHO, BEATRIZ MARTINHÃO HIGA, MAURICIO PEREIRA DA SILVA FILHO, ANA THEREZA BISSOLI, JUNIOR RODRIGUES SOARES, JUNEA CARIS DE OLIVEIRA