Emoto Shin, Homma Shigenori, Yoshida Tadashi, Ichikawa Nobuki, Miyaoka Yoichi, Matsui Hiroki, Takahashi Ryo, Ishido Keita, Otsuka Takuya, Mitsuhashi Tomoko, Katsurada Takehiko, Taketomi Akinobu
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Department of Surgical Pathology, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
Surg Case Rep. 2021 May 13;7(1):122. doi: 10.1186/s40792-021-01206-7.
The improved prognosis of Crohn's disease may increase the opportunities of surgical treatment for patients with Crohn's disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn's disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally.
A 51-year-old man had been diagnosed with Crohn's disease 35 years earlier and had undergone several operations for treatment of Crohn's colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed.
The transperineal approach might be useful in patients with Crohn's disease who develop rectal cancer after multiple abdominal surgeries.
克罗恩病预后的改善可能增加克罗恩病患者接受手术治疗的机会以及患结直肠癌的风险。我们在此描述一名患有克罗恩病且有多次手术史的患者，其发生了直肠残端癌，并接受了腹腔镜和经会阴联合治疗。
一名51岁男性在35年前被诊断为克罗恩病，曾因克罗恩结肠炎接受过多次手术。进行结肠镜检查时发现残留直肠处患有直肠癌。该患者随后被转诊至我科。肿瘤被诊断为临床T2N0M0，I期。我们通过腹腔镜手术联合经会阴直肠切除术治疗该肿瘤。在腹腔镜下分离腹腔内粘连的同时，经会阴途径在正确层面进行直肠分离。直肠癌切除时切缘未受累。手术时长3小时48分钟，失血量50毫升，术中未发生并发症。肿瘤的病理诊断为5型高分化和中分化腺癌，pT2N0，I期。术后3个月无复发迹象，未进行辅助化疗。
经会阴途径可能对多次腹部手术后发生直肠癌的克罗恩病患者有用。
