Osone Katsuya, Ogawa Hiroomi, Katayama Chika, Shibasaki Yuta, Suga Kunihiko, Komine Chika, Ozawa Naoya, Okada Takuhisa, Shiraishi Takuya, Katoh Ryuji, Sakai Makoto, Sano Akihiko, Yokobori Takehiko, Matsumura Nozomi, Sohda Makoto, Shirabe Ken, Saeki Hiroshi
Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan.
Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan.
Surg Case Rep. 2021 Jan 26;7(1):32. doi: 10.1186/s40792-021-01118-6.
No standard treatment for anorectal fistula cancer, such as multidisciplinary therapy, has been established due to the rarity of the disease. Herein, we investigated patients with cancer associated with anorectal fistula who underwent surgery to clarify the clinicopathological characteristics and to propose future perspectives for treatment strategies.
Seven patients with cancer associated with anorectal fistula who underwent rectal amputation in our institute were analyzed with regard to clinical characteristics, pathological findings, surgical results, and prognosis. Four cases had Crohn's disease as an underlying cause. All seven cases were diagnosed as advanced stage. Preoperative [F]-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (FDG-PET/CT) showed abnormal FDG accumulation in six cases including four mucinous adenocarcinomas. Three cases that received preoperative hyperthermo-chemoradiotherapy achieved pathological R0 resection. Postoperative recurrence was observed in four cases including three with Crohn's disease and one resulting in death.
Anorectal fistula cancer is rare and difficult to be diagnosed at early stages. Mucinous adenocarcinoma associated with anorectal fistula tends to exhibit abnormal FDG accumulation by FDG-PET/CT unlike common colorectal mucinous adenocarcinoma. Preoperative hyperthermo-chemoradiotherapy may be effective in obtaining pathological complete resection.
由于肛管直肠瘘癌罕见，尚未确立多学科治疗等标准治疗方法。在此，我们对接受手术治疗的肛管直肠瘘相关癌症患者进行了调查，以明确其临床病理特征，并为治疗策略提出未来展望。
对我院7例因肛管直肠瘘相关癌症接受直肠切除术的患者的临床特征、病理结果、手术结果及预后进行了分析。4例患者以克罗恩病为潜在病因。所有7例均被诊断为晚期。术前[F]-氟代脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）显示6例有异常FDG聚集，其中4例为黏液腺癌。3例接受术前热化疗放疗的患者实现了病理R0切除。4例出现术后复发，其中3例患有克罗恩病，1例死亡。
肛管直肠瘘癌罕见，早期难以诊断。与普通结直肠黏液腺癌不同，与肛管直肠瘘相关的黏液腺癌通过FDG-PET/CT往往表现出异常FDG聚集。术前热化疗放疗可能有助于实现病理完全切除。
