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Pelvic exenteration in a patient with Rectum Adenocarcinoma: Case Report
Apresentação do caso
Make 65-year-old patient, smoker, alcoholic, with no other comorbidities. He was seen in February 2020 with a complaint of painful lesions in the perineal region for 01 year, evolving with tenesmus, fecal incontinence and pollakiuria. On physical examination, the patient was in good general condition (ECOG 1), with an ulcerated tumor on the anal border and right gluteus, and a palpable lesion 7cm from the anal border. Abdominal tomography with tumor in the retrovesical region, involving the prostate, seminal vesicles, anus and pelvic floor, involving the gluteal muscles and the origin of the ischio-tibial muscles. CEA 13.3. Biopsy showing mucosecretory adenocarcinoma infiltration, with stable genotype. Submitted to colostomy and neoadjuvant with chemoradiotherapy. On clinical re-evaluation of restaging, there were no signs of disease regression or progression. Total pelvic exenteration with Bricker urinary reconstruction and primary perineal closure was performed. Histopathological: mucinous adenocarcinoma with free margins, lymph nodes 0/19, ypT4bpN0, EIIC. He was not submitted to adjuvant due to performance (ECOG 3). Currently in the third month after surgery, with good evolution, the patient is in multidisciplinary outpatient follow-up, adapted to the stomas.
Locally advanced primary rectal cancer (LARC) occurs when there is tumor invasion or adherence to local tissues without distant metastases. It can cause problems as pain, defecations problems, voiding and results as decreased quality of life. (3,4).
Pelvic exenteration (PE) to remove advanced rectal cancer or recurrent cancer is technically challenging and a complex surgery with a particularly high morbidity rate(1,5). Surgery consists en bloc removal of the rectosigmoid with compromised adjacent organs, as like surrounding lymph nodes, internal reproductive organs, bladder, distal ureters, sigmoid colon, rectum and pelvic peritoneum (6,2). Provide complete resection with clear circumferential and distal margins (R0 resection) is the end point of exenteration (2). Clean margins with an R0 ressection is the best predictor of long-term survival (2).
LARC can bring symptoms, such as those presented in this case, which directly affect the patient's quality of life. Pelvic exenteration, despite being a surgery with a high morbidity rate and technically challenging, has the possibility of curing the disease when its goal of R0 resection is reached, which is the best predictor of long-term survival.
pelvic exanteration, colorectal neoplasms, locally advanced pelvic cancer
Tumores colorretais e canal anal
BEATRIZ MARTINHAO HIGA, RENATO MORATO ZANATTO, JUNEA CARIS DE OLIVEIRA, KARLA THAIZA TOMAL, VITOR AUGUSTO MELAO MARTINHO, MAURICIO PEREIRA DA SILVA FILHO, ANA THEREZA BISSOLI, JUNIOR RODRIGUES SOARES, FLAVIA FERREIRA MAGALINI, EDUARDO MARCUCCI PRACUCHO