Zhang Si-Qi, Liu Kui-Jie, Yao Hong-Liang, Lei San-Lin, Lei Zhen-Dong, Yi Wen-Jun, Xiong Li, Zhao Hua
Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.
World J Clin Cases. 2019 Mar 26;7(6):798-804. doi: 10.12998/wjcc.v7.i6.798.
The rate of positive resection margins (R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy (PDT) as a remedial treatment for esophageal cancer. Colorectal cancer and esophageal cancer has many similarities, however, PDT as a salvage therapy for rectal cancer is rare.
Here, we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia, which had been aggravated for 1 mo. Colonoscopy revealed a 3 cm × 4 cm ulcerated mass in the rectum 4 cm from the anus. Preoperative pathological examination showed villous adenoma, moderate-to-high-grade dysplasia, good differentiation, and invasion of the mucosal muscle. The patient had R1 after ultra-low anterior resection, but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately, the patient underwent PDT to remove R1. After five years of follow-up, there was no liver function impairment, recurrence, metastasis, sexual dysfunction, or abnormal defecation function.
This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.
低位直肠癌患者的切缘阳性（R1）率较高。推荐的补救措施如扩大切除术或放化疗都有其严重弊端。据报道，光动力疗法（PDT）可作为食管癌的补救治疗方法。结直肠癌和食管癌有许多相似之处，然而，PDT作为直肠癌的挽救治疗方法却很少见。
在此，我们描述一名56岁男性，因便血6个月、加重1个月入院。结肠镜检查发现距肛门4 cm处直肠有一个3 cm×4 cm的溃疡性肿块。术前病理检查显示绒毛状腺瘤，中高级别异型增生，分化良好，侵犯黏膜肌层。该患者行超低位前切除术后切缘阳性，但拒绝扩大切除术，且在3周期化疗后出现严重肝功能损害。最终，该患者接受PDT以清除切缘阳性病灶。经过5年随访，未出现肝功能损害、复发、转移、性功能障碍或排便功能异常。
这是世界上首例通过PDT成功治疗直肠癌切缘阳性的病例。
