Tung Jivatesh, Lin Bruce, Schlenker James, Simianu Vlad V
Section of Colon and Rectal Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Section of Hematology-Oncology, Department of Medicine, Virginia Mason Medical Center, Seattle, WA, USA.
Ann Med Surg (Lond). 2022 Jan 25;74:103291. doi: 10.1016/j.amsu.2022.103291. eCollection 2022 Feb.
A 69-year-old male truck driver with history of chronic anal fissures and facial basal cell carcinoma developed rectal bleeding and pain, and was diagnosed with a 5cm basal cell cancer of the anus with sphincter invasion. His workup entailed physical exam, CT and MRI which confirmed external and internal sphincter invasion without evidence of distant metastatic disease. After review of chemoradiation and surgical options, the patient elected to proceed with robotic-assisted abdominoperineal resection with end colostomy with complex local-tissue reconstruction. He is now two years out and disease free. While radiation and surgery have both been described in the literature as viable treatments, surgical resection may be the best option for patients with large lesions with sphincter invasion, who travel from afar and have occupational restrictions. This case highlights the importance of a multidisciplinary approach in assessing the patient with a rare disease process, presenting all viable options for treatment, and electing the optimal treatment through shared decision making.
一名69岁男性卡车司机，有慢性肛裂和面部基底细胞癌病史，出现直肠出血和疼痛，被诊断为肛门基底细胞癌，肿瘤大小5cm，侵犯括约肌。其检查包括体格检查、CT和MRI，证实括约肌内外均受侵犯，无远处转移疾病证据。在评估了放化疗和手术方案后，患者选择进行机器人辅助腹会阴切除术加结肠造口术，并进行复杂的局部组织重建。他现在已术后两年，无疾病复发。虽然文献中已将放疗和手术描述为可行的治疗方法，但对于有括约肌侵犯的大病变患者、远道而来且有职业限制的患者，手术切除可能是最佳选择。本病例强调了多学科方法在评估患有罕见疾病过程的患者、提供所有可行治疗方案以及通过共同决策选择最佳治疗方案方面的重要性。
