ABSTRACT
Surgery and management of rectal cancer have made significant progress in recent decades. However, there is still no coloanal anastomosis technique that offers a good compromise between functionality and low morbidity. The aim of this study is to evaluate the safety and efficiency of the modified delayed coloanal anastomosis (mDCA). In this retrospective study, we analyzed the morbi-mortality as well as functional outcomes of 19 patients treated with mDCA, out of 73 colorectal cancer patients treated at our institution from September 2021 to June 2023. The inclusion criteria were cancer of the mid and low rectum (tumor less than 10 cm from the anal verge). Morbidity represented by complications of Clavien-Dindo grade III or higher was estimated at 5.2%. Only one patient experienced an asymptomatic anastomotic leak (AL) grade A. Ischemia of the colonic stump occurred in one patient, taken back to the OR on the 5th postoperative day. No stump retraction was noted. Anastomotic stenosis appeared in one patient (5.2%) during the 90-day postoperative period, and was treated by instrumental dilation. Perioperative mortality was nil. The mean St Marks incontinence score at 90 days was 13.2 points. At the 3-month follow-up, 15 patients (78.9%) had major low anterior resection syndrome (LARS), three (15.7%) had minor LARS, and one patient (5.2%) had no LARS. None of the patients had a diversion loop ileostomy. The mDCA, by decreasing the rate of AL, without the need for diversion ileostomy, might be an interesting alternative to the conventional immediate coloanal anastomosis (ICA), for restoring the GI tract after proctectomy for cancer.
ABSTRACT
Ectopic breast tissue can arise at any point along the primitive milk line, which runs from the axilla to the groin. The incidence of ectopic breast cancer ranges from 0.2% to 0.6%. We report the case of a 60-year-old woman with a history of left mastectomy for breast cancer one year prior to presentation, who presented with bilateral vulvar erosion found to be a moderately differentiated adenocarcinoma on biopsy. The extension workup being negative, a radical vulvectomy was performed. The postoperative course was uneventful, and the specimen's pathologic study revealed a vulvar localization of non-specific invasive breast carcinoma. It was positive for estrogen receptor and human epidermal growth factor receptor 2/neu, and negative for progesterone receptor. Adjuvant chemoradiotherapy was given to the patient. There is no dedicated guideline for both diagnosis and management of this particular tumor; the treatment is similar to that of orthotopic breast cancer. (AU)
El tejido de mama ectópico puede presentarse en cualquier punto de la línea de la leche primitiva, que discurre desde la axila a la ingle. La incidencia de cáncer de mama ectópico oscila entre el 0,2 y el 0,6%. Reportamos el caso de una mujer de 60 años con historia de mastectomía izquierda por cáncer de mama un año antes de la presentación, que acudió con erosión bilateral en la vulva, que fue considerada un adenocarcinoma moderadamente diferenciado en la biopsia. Siendo negativas las pruebas complementarias, se realizó una vulvectomía radical. El curso postoperatorio transcurrió sin incidentes, y el estudio de la muestra patológica reveló la localización en la vulva de un cáncer de mama invasivo no específico, que fue positivo para receptor de estrógenos y receptor del factor de crecimiento epidérmico humano 2/neu, y negativo para el receptor de progesterona. Se administró quimioterapia adyuvante a la paciente. No existen directrices especializadas para el diagnóstico y manejo de este tumor particular, siendo su tratamiento similar al del cáncer de mama ortotópico. (AU)
Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms , Vulvar Neoplasms , Neoplasms, Second Primary , VulvectomyABSTRACT
Introduction: In current clinical practice, immediate coloanal anastomosis (ICA) remains the standard technique for restoring the gastrointestinal tract following coloproctectomy for low rectal cancer. This anastomosis still requires a temporary diverting stoma to decrease the postoperative morbidity, which remains significantly high. As an alternative, some authors have proposed a two-stage delayed coloanal anastomosis (TS-DCA). This article reports on the surgical technique of TS-DCA. Methods: The case described is of a 53-year-old woman, without any particular history, in whom colonoscopy motivated by rectal bleeding revealed an adenocarcinoma of the low rectum. Magnetic resonance imaging showed a tumor ~ 1 cm above the puborectalis muscle, graded cT3N +. The extension workup was negative. Seven weeks after chemoradiotherapy, a coloproctectomy with total mesorectal excision (TME) was performed. A TS-DCA was chosen to restore the digestive tract. Conclusion: Two-stage delayed coloanal anastomosis is a safe and effective alternative for restoring the digestive tract after proctectomy for low rectal cancer. Recent data seem to show a clear advantage of this technique in terms of morbidity. (AU)
