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TOTAL PELVIC EXENTERATION FOR PRIMARY LOCALLY ADVANCED RECTAL CANCER: A CASE REPORT
Apresentação do caso
A 62 year old man attended to the outpatient department with hematochezia, anal pain and erectile dysfunction. The digital rectal examination revealed normotonic anal sphincter, an elevated, hardned lesion fixed on anterior and posterior rectal walls. The lesion was located 2 cm from the anal margin. Colonoscopy showed na infiltrative lesion in distal rectum. Bipsy revealed moderately differentiated adenocarcinoma. Computed Tomography disclosed a soft tissue mass in distal rectum without cleavage planes with prostate wall. Mesorectal fat infiltration and increased local lymph nodes was noted. Distant metastases were absent. CEA: 63, cT4N1M0. Clinical Stading: IIIB. Patient was submitted to neoadjuvant chemoradiotherapy. After 8 weeks underwent surgery and a total pelvic exenteration was required to assure a complet (R0) resection. ypT1N0M0 – Pathology Standing: I.
Total pelvic exenteration involves en bloc resection of distal colon, rectum, bladder, distal ureter, prostate and draining lymph nodes. In this case was included anal amputation with terminal colostomy and cystectomy with ileal conduit (Bricker). It is usually difficult to assess whether the involvement of another organ is present at the time of surgery if it is a neoplasic invasion or inflammation. Pelvic exenteration provides a negative surgery margin as in this case. Neoadjuvant chemoradiotherapy is the standard treatmentfor locally advanced rectal cancer according to literature. It reduces tumor size, increases lesion resection rate and decreases loco-regional recurrence.
Pelvic exenteration is a high morbidity procedure but is the surgical choice in locally advanced rectal tumors when doubt of others pelvic organs involvement, and associated with neoadjuvant chemoradiotherapy may improve local control rate and long -term survival rate.
PELVIC EXENTERATION, NEOADJUVANT CHEMORADIOTHERAPY
ANA THEREZA BISSOLI, RENATO MORATO ZANATTO, JUNEA CARIS OLIVEIRA, EDUARDO MARCUCCI PRACUCHO, CELSO ROBERTO PASSERI, BEATRIZ MARTINHÃO HIGA, JUNIOR RODRIGUES SOARES, MAURICIO PEREIRA SILVA FILHO, VITOR AUGUSTO MELAO MARTINHO, KARLA THAIZA TOMAL