Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients’ Returning to Work (START): A Multi-center, Randomized Controlled Trial / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We developed a comprehensive return to work (RTW) intervention covering physical, psycho-social and practical issues for patients newly diagnosed and evaluated its efficacy in terms of RTW. @*Materials and Methods@#A multi-center randomized controlled trial was done to evaluate the efficacy of the intervention conducted at two university-based cancer centers in Korea. The intervention program comprised educational material at diagnosis, a face-to-face educational session at completion of active treatment, and three individualized telephone counseling sessions. The control group received other education at enrollment. @*Results@#At 1-month post-intervention (T2), the intervention group was more likely to be working compared to the control group after controlling working status at diagnosis (65.4% vs. 55.9%, p=0.037). Among patients who did not work at baseline, the intervention group was 1.99-times more likely to be working at T2. The mean of knowledge score was higher in the intervention group compared to the control group (7.4 vs. 6.8, p=0.029). At the 1-year follow-up, the intervention group was 65% (95% confidence interval, 0.78 to 3.48) more likely to have higher odds for having work. @*Conclusion@#The intervention improved work-related knowledge and was effective in facilitating cancer patients’ RTW.

Corrigendum: Correction of the IRB Approval Number. Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center

The IRB approval number should be corrected.

Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center

PURPOSE: In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred. METHODS: Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging. RESULTS: The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively. CONCLUSION: CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.

Preoperative thrombocytosis predicts prognosis in stage II colorectal cancer patients

PURPOSE: Thrombocytosis is known to be a poor prognostic factor in several types of solid tumors. The prognostic role of preoperative thrombocytosis in colorectal cancer remains limited. The aim of this study is to investigate the prognostic role of preoperative thrombocytosis in stage II colorectal cancer. METHODS: Two hundred eighty-four patients with stage II colorectal cancer who underwent surgical resection between December 2003 and December 2009 were retrospectively reviewed. Thrombocytosis was defined as platelet > 450 × 10(9)/L. We compared patients with thrombocytosis and those without thrombocytosis in terms of survival. RESULTS: The 5-year disease-free survival (DFS) rates were lower in patients with thrombocytosis compared to those without thrombocytosis in stage II colorectal cancer (73.3% vs. 89.6%, P = 0.021). Cox multivariate analysis demonstrated that thrombocytosis (hazard ratio, 2.945; 95% confidence interval, 1.127-7.697; P = 0.028) was independently associated with DFS in patients with stage II colorectal cancer. CONCLUSION: This study showed that thrombocytosis is a prognostic factor predicting DFS in stage II colorectal cancer patients.

Oncologic outcomes following metastasectomy in colorectal cancer patients developing distant metastases after initial treatment

PURPOSE: We performed a comparative analysis of the clinicopathologic features and oncologic outcomes of colorectal cancer patients with metachronous versus synchronous metastasis, according to the prognostic factors. METHODS: Ninety-three patients who underwent curative resection for distant metastatic colorectal cancer were included in the study between December 2001 and December 2011. We assessed recurrence-free survival and overall survival in patients with distant metastasis who underwent curative surgery. RESULTS: The most common site of distant metastasis was lung alone (n = 19, 51.4%) in patients with metachronous metastasis, while liver alone was most common in those with synchronous metastasis (n = 40, 71.4%). Overall survival rate was significantly different between patients with synchronous metastasis and metachronous metastasis (34.0% vs. 53.7%; P = 0.013). Incomplete resection of the metastatic lesion was significantly related to poor overall survival in both, patients with synchronous metastasis, and metachronous metastasis. CONCLUSION: Our study indicates that patients developing distant metastasis after initial treatment show a different metastatic pattern and better oncologic outcomes, as compared to those presenting with distant metastasis. Resection with tumor free margins significantly improves survival in patients with metachronous as well as synchronous metastasis.

Clinical application of sentinel lymph node mapping in colon cancer: in vivo vs. ex vivo techniques

PURPOSE: Clinical usefulness of sentinel lymph node (SLN) mapping in colorectal cancer remains controversial. The aim of this study is to evaluate the accuracy of the SLN mapping technique using serial sectioning, and to compare the results between ex vivo and in vivo techniques. METHODS: From February 2011 to October 2012, 34 colon cancer patients underwent SLN mapping during surgical resection. Eleven patients were analyzed with the in vivo method, and 23 patients with the ex vivo method. Patient characteristics and results of SLN mapping were evaluated. RESULTS: The SLN mapping was performed in 34 patients. Mean age was 67.3 years (range, 44-81 years). Primary tumors were located in the following sites: 13 in the right colon (38.2%) and 21 in the left colon (61.8%). SLN mapping was performed successfully in 88.2% of the patients. There was no significant difference in the identification rate between the two methods (90.9% vs. 87.0%, P = 1.000). Both the mapping methods showed a low sensitivity and high rate of skip metastasis. CONCLUSION: This study showed that SLN evaluation using serial sectioning could not predict the nodal status with clinically acceptable accuracy despite the high detection rate.

Preoperative Localization of Early Colorectal Cancer or a Malignant Polyp by Using the Patient's Own Blood

PURPOSE: Preoperative localization is the most important preparation for laparoscopic surgery. Preoperative marking with India ink has widely been used and is considered to be safe and effective. However, India ink can cause significant inflammation, adhesions and bowel obstruction. Therefore, we have used the patient's blood instead of the ink since 2011. In this retrospective study, we wanted to examine the feasibility of preoperative localization by using the patient's blood. METHODS: Twenty-five patients who underwent preoperative localization in which 10 mL of their own venous blood was used as a tattooing agent were included in this study. The characteristics of the patients, the anatomy of the colon cancer, and the efficacy and the side effects of using this procedure were analyzed. RESULTS: In 23 cases (92%), through the laparoscope, we found perfectly localized bloody smudges in the serosa. However, in 2 cases (8%), we could not find the exact location of the lesion. No patients showed any complications. CONCLUSION: Preoperative localization of early colon cancer or a malignant polyp by using patient's blood is feasible, safe and simple. We think that using the patient's blood for localization of a lesion is better than using some other foreign material such as India ink.

Preoperative Colonoscopy for Detection of Synchronous Neoplasms after Insertion of Self-Expandable Metal Stents in Occlusive Colorectal Cancer: Comparison of Covered and Uncovered Stents

BACKGROUND/AIMS: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents. METHODS: Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents. RESULTS: Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent. CONCLUSIONS: A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction.

Risk factors for parastomal hernia: based on radiological definition / 대한외과학회지

PURPOSE: The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia and to analyze the risk factors for parastomal hernia. METHODS: We reviewed retrospectively 108 patients with end colostomy from January 2003 to June 2010. Age, sex, surgical procedure type, body mass index (kg/m2), stoma size, and respiratory comorbidity were documented. RESULTS: There were 61 males (56.5%) and 47 females (43.5%). During an overall median follow-up of 25 months (range, 6 to 73 months), 36 patients (33.3%) developed a radiological parastomal hernia postoperatively and 29 patients (26.9%) presented with a clinical parastomal hernia. In multivariate analysis, gender (odds ratio [OR], 6.087; P = 0.008), age (OR, 1.109; P = 0.009) and aperture size (OR, 6.907; P < 0.001) proved to be significant and independent risk factors after logistic regression analysis. CONCLUSION: This study showed that the incidence of radiological parastomal hernia is higher than clinical parastomal hernia. Risk factors for parastomal hernia proved to be female, age, and aperture size.

Routine barium enema prior to closure of defunctioning ileostomy is not necessary / 대한외과학회지

PURPOSE: The use of barium enemas to confirm the anastomotic integrity prior to ileostomy closure is still controversial. The purpose of the study was to determine the utility of routine contrast enema prior to ileostomy closure and its impact on patient management in patients with a low pelvic anastomosis. METHODS: One hundred forty-five patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for rectal cancer. All patients were evaluated by physical examination, proctoscopy, and barium enema prior to ileostomy closure. RESULTS: The median time from ileostomy creation to closure was 8 months. Five (3.5%) of the 144 patients were found to have clinically relevant strictures at the colorectal anastomosis on routine barium enema. One patient (0.7%) showed anastomotic leak on their barium enema. Overall, 141 patients (97.9%) had an uncomplicated postoperative course. Postoperative complication occurred in three patients (2.1%). None of them showed abnormal barium enema finding, which suggested that routine contrast enema examination did not predict postoperative complication. CONCLUSION: Routine barium enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information for postoperative colorectal anastomotic complication.

Computed tomography classification for parastomal hernia / 대한외과학회지

PURPOSE: The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia. METHODS: We reviewed, retrospectively, 83 patients with end colostomy operated on from January 2003 to June 2009 at Ajou University hospital. Age, sex, surgical procedure type, body mass index (weight/length2), stoma size, and respiratory co-morbidity were documented. We compared the incidence of radiological and clinical parastomal hernia. RESULTS: There were 47 males (56.6%) and 36 females (43.4%). During an overall median follow-up of 30 months (range, 6 to 45 months), 24 patients (28.9%) developed a radiological parastomal hernia postoperatively and 20 patients (24.1%) presented clinical symptoms. Using computed tomography (CT) classification, the groups were as follows: type 0 (40, 48.2%), type Ia (19, 22.9%), type Ib (8, 9.6%), type II (4, 4.8%) and type III (12, 14.5%), with 63 asymptomatic patients and 20 symptomatic patients. The aperture size was significantly different between symptomatic and asymptomatic patients (76.45 mm vs. 49.41 mm; P = 0.000). There was a significant correlation between aperture size and the radiological type (P = 0.003). CONCLUSION: This study showed the incidence of radiological parastomal hernia is acceptable compared to previous studies. CT classification may be useful to evaluate parastomal hernia.

Is Preoperative Chemotherapy Safe for Patients with Colorectal Liver Metastases Undergoing Metastasectomy?

PURPOSE: Controversies regarding preoperative versus postoperative chemotherapy for patients having hepatic metastases of colorectal primary made us elucidate the safety of chemotherapy. By examining the histopathologic changes in the liver following preoperative chemotherapy and analyzing the relation between surgical outcomes and preoperative chemotherapy, we were able to answer whether preoperative chemotherapy is safe. METHODS: We analyzed 38 patients who underwent chemotherapy before resection of hepatic metastasis from colorectal primary, retrospectively. Types of chemotherapy regimen were FL (5-FU+leucovorin), FOLFOX4 (oxaliplatin+5-FU+leucovorin), and FOLFIRI (irinotecan+5-FU+leucovorin). Results of liver function tests were compared before and after preoperative chemotherapy. One pathologist reviewed the degree of hepatic injury from resected specimens. Associations between the histological findings of hepatic injury and surgical outcomes and chemotherapeutic agents were examined. RESULTS: Histopathologic analysis revealed severe liver injury was present in 12 patients (31.6%). In further detail, moderate to severe sinusoidal dilatation was found in 3 patients (25%), steatosis of more than 30% was identified in 9 patients (75%), and steatohepatitis Kleiner score of > or =4 in 5 patients (41.7%). Preoperative chemotherapy did not affect the biochemical profiles of liver function. The overall perioperative complication rate was 5.3% (n=2). There was no difference in postoperative morbidity or mortality from reported results following hepatectomy. CONCLUSION: We found preoperative chemotherapy definitely induced histopathologic changes of hepatotoxicities. Even so, preoperative chemotherapy did not increase morbidity or mortality after hepatic metastasectomy. Preoperative chemotherapy seems to be safe in performing curative hepatic resection for the metastases.

Microsatellite Instability-low Colorectal Carcinomas: Are They Comparable with Microsatellite Stable Cancer?

PURPOSE: Microsatellite instability-high (MSI-H) colorectal cancer (CRC) displays a well-described distinct phenotype, but the true biological significance of MSI-low (L) is still uncertain. To clarify the significance of this MSI-L, we studied the differences between patients with CRC with MSI-H, MSI-L, and microsatellite stability (MSS). METHODS: A total of 723 consecutive patients (429 males and 294 females) who had undergone resections between September 2002 and August 2007 were studied. We analyzed the clinicopathological features, the MSI statuses, and the prognoses of the 723 CRC patients. RESULTS: MSI-H was observed in 54 (7.5%), MSI-L in 27 (3.7%), and MSS in 642 (88.8%) of the 723 colorectal cancer patients. MSI-L and MSS CRC share similar clinicopathological features. A univariate analysis showed no significant differences in overall survival between MSI-L, MSS, and MSI-H. In the multivariate Cox regression analysis, MSI-L was significantly (P=0.036) associated with poorer prognosis compared with MSS tumors, after adjustment for factors previous shown to be associated with the survival based on potentially relevant variables. CONCLUSION: In conclusion, the current study showed no difference in the clinicopathological features of MSI-L versus MSS CRCs. However, in the multivariate analysis, patients with MSI-L CRCs had significantly poorer overall survival. Finally, these findings support the existence of MSI-L CRCs as a distinct category. Thus, further studies are required to explore possible reasons for the adverse prognosis associated with MSI-L cancers.

Total Number of Lymph Nodes Retrieved in Stage III Rectal Cancer Patient

PURPOSE: Adequate lymph node analysis is critical for appropriate staging in colorectal cancer. The aim of this study is to determine whether 12 or more nodes recovered in stage III rectal cancer results in improved oncologic outcomes. METHODS: Two hundred and forty-eight patients with stage III rectal cancer from 1995 through 2004 were reviewed. They were categorized into 2 subgroups by the number of nodes retrieved ( or =12), and oncologic outcomes in terms of 5-year overall and disease-free survival were analyzed for all patients, patients with American Joint Committee on Cancer (AJCC) N1 disease (N=145), and those with AJCC N2 (N=103). RESULTS: Five-year overall and disease-free survival was 79.0% and 58.4%, respectively. There was no significant difference in clincopathologic features between or =12 group. Although there was significant difference in overall survival and disease-free survival between the number ( or =12) of lymph nodes removed in N2 disease (P=0.043; P=0.022) in univariate analysis, the total number of lymph nodes retrieved was not a prognostic factor affecting survival in multivariate analysis. The N2 stage and lateral margin involvement were prognostic factors affecting survival in multivariate analysis. CONCLUSION: This study showed that the total number of lymph nodes analyzed for stage III rectal cancer is not a prognostic factor on overall or disease-free survival in multivariate analysis.

Gastrointestinal Stromal Tumors of the Colon and Rectum

PURPOSE: This study was designed to review the clinical characteristics of gastrointestinal stromal tumors (GISTs) of the colon and rectum and to evaluate their immunohistochemical and pathologic features based on the current National Institutes of Health criteria. METHODS: Patient and disease characteristics, pathologic features, surgical or endoscopic management, and clinical outcomes of 11 patients with GISTs diagnosed and primarily treated at our institution between March 1995 and February 2009 were evaluated. RESULTS: Colorectal GISTs accounted for 4.4% of all GISTs. The primary location was the rectum (8 cases). Four patients had high-risk GISTs, 4 patients had low-risk GISTs, and 3 patients had very low-risk GISTs. All tumors were c-kit positive. Four patients underwent a radical resection, whereas 7 patients underwent an endoscopic resection (n=3) or a transanal excision (n=4). Two high-risk patients without adjuvant Imatinib mesylate therapy developed metastases, but the other high-risk patients with adjuvant Imatinib mesylate therapy didn't. CONCLUSION: Colorectal GISTs occurred predominantly in the rectum. Because GISTs do not metastasize through the lymphatics, small GISTs that are amenable to local excision or endoscopic resection can be treated by either of these techniques as long as negative microscopic margins are obtained around the primary tumor. Patients with high-risk GISTs should be considered for the use of Imatinib mesylate as adjuvant therapy.

Treatment of Multiple Colorectal Cancers

PURPOSE: The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers. METHODS: A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded. RESULTS: There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33+/-11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy. CONCLUSION: Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer.

Does a Successful Total Mesorectal ExcisionRequire a Learning Curve?

PURPOSE: This study was conducted to determine whether a learning curve is necessary to obtain a successful total mesorectal excision (TME) for mid or low rectal cancer. METHODS: We retrospectively reviewed the records of 80 patients that underwent a total mesorectal excision for mid or low rectal cancer between 1994 and 1998 and between 1999 and 2002. We compared the results between the two period groups. Endpoints were postoperative urological functions and the local recurrence rate. RESULTS: There was no significant difference for age, gender, tumor differentiation and stage between patients in the two groups. Local recurrence (LR) developed in 23% of patients in the early group and 7.5% of patients in the late group. The cumulative LR risk at 60 months was 27.5% for the early period group and 9.9% for the late period group (P=0.082) and the difference between the two groups was significant for TNM III stage (29.8% vs. 9.8%, P=0.049). Postoperative urological complications were not significantly different between the two groups (P=0.75). CONCLUSION: Based on these results, TME seemed to require a learning curve. In clinical trials for rectal cancer surgery, the learning curve for qualified surgery from the standpoint of oncological outcome should be considered to minimize bias due to surgeon-associated factors. A more broad application of the TME concept to a larger number of patients with mid or low rectal cancer is warranted.

The Efficacy of UGT1A1 Polymorphism in Chemoradiation Therapy Using Irinotecan in Patients with Locally Advanced Rectal Cancer

PURPOSE: Irinotecan (CPT-11) is hydrolyzed to an active SN-38, which is further detoxicated to SN-38G through conjugation by uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) enzymes. There are many reports that UGT1A1 polymorphisms are associated with irinotecan related dose-limiting toxicity. The aim of the present study is to determine whether UGT1A1 polymorphisms affect individual variations of the toxicity due to and the tumor response to irinotecan via the alteration of bioavailability of SN-38 in Korean patients with locally advanced rectal cancer. METHODS: Twenty patients with locally advanced rectal cancer, who had received surgery after irinotecan-containing chemoradiation from 2003 to 2006, were enrolled. We analyzed the association of UGT1A1 genotypes with toxicity and tumor response to chemoradiation therapy. A tumor response was assumed when a tumor regression grade I or II was obtained. Toxicity was graded in accordance with the NCI common toxicity criteria. RESULTS: The frequence of square53(TA)6>7 (UGT1A1*28), 211G>A (UGT1A1*6), 686C>A (UGT1A1*27), square3279T>G (UGT1A1*60), and square3156G>A were 25% (5/20), 25% (5/20), 0% (0/20), 55% (11/20), and 20% (4/20), respectively. There were five grade III neutropenia and one severe diarrhea. Patients with UGT1A1*28 and square3156G>A showed higher complete tumor response rates (40% vs. 6.7%, P=0.07; 50% vs. 6.3%, P=0.08), but there was no differences in toxicity and tumor response between responders and non-responders. Patients with square3279T>G (UGT1A1*60) showed a tendency for lower tumor response in tumor responders, but there was no statistically significant difference (P=0.07). CONCLUSIONS: This study suggested that square3279T>G (UGT1A1*60) may be useful in predicting tumor response of irinotecan. In the future, further study is warranted using large numbers of cases to reach statistical significance.

Comparison of Laparoscopy-assisted Total Gastrectomy with Conventional Open Total Gastrectomy for Treating Early Proximal Gastric Cancer

PURPOSE: The purpose of this study was to compare the short-term clinical outcomes of laparoscopy-assisted total gastrectomy (LATG) with conventional open total gastrectomy (OTG) for treating proximal early gastric cancer and to determine the usefulness of the LATG procedure. METHODS: The records of 21 patients who underwent LATG for proximal early gastric cancer from January 2004 to August 2006 were retrospectively reviewed and compared with those records of 20 patients who underwent OTG during the same period. RESULTS: The patient characteristics, including gender, age, body mass index and comorbidities, were similar between the two groups. Combined resections were more frequently done in the OTG group than in the LATG group. The blood loss in the LATG group was significantly less than that in the OTG group. The operating time, time to first flatus and initial oral intake and the postoperative hospital stay were significantly shorter in the LATG group. The number of resected lymph nodes, lymph node metastasis, histologic type, TNM stage, complications, leukocyte counts and serum lactic acid levels were not significantly different between the two groups. CONCLUSION: LATG is a technically safe and feasible procedure for treating proximal early gastric cancer. Prospective multi-center trials are necessary to establish LATG as the standard treatment for proximal early gastric cancer.

Primitive Neuroectodermal Tumor on the Buttock

Primitive neuroectodermal tumors (PNET) usually arise in the brain and central nervous system, but rarely occur outside of the brain, such as in the limbs, pelvis, paravertebral region or chest wall. Herein, a case of PNET on the buttocks is reported. A 24-year-old female was admitted for evaluation of a mass on her left buttock. An incisional biopsy revealed a primitive neuroectodermal tumor, with focal neural differentiation histologically. Preoperative MRI demonstrated the tumor was located in the subcutaneous layer of the left perineum, and extended to the ischiorectal fossa. The lesion showed an irregular, but well defined border; however, the differentiation from the left posterior wall of anus was focally obliterated. On operation, the tumor was not adhered to the surrounding structure, except for the external anal sphincter. The mass was completely resected. The tumor was about 8 x 9 x 5.8 cm in size, and the pathological evaluation confirmed a PNET, with a free anal sphincter margin. Therefore, chemoradiation therapy was planned, but the tumor recurred two months later. It was recommended the patient undergo a re-resection, but was lost before the procedure could be undertaken.