Yoshida Shoma, Tanida Tsukasa, Ikenaga Masakazu, Oka Keishi, Taguchi Daisuke, Fukushima Shoko, Yukimoto Ryohei, Iede Kiyotsugu, Ueda Masami, Tsuda Yujiro, Nakashima Shinsuke, Matsuyama Jin, Yamada Terumasa
Dept. of Gastroenterological Surgery, Higashiosaka City Medical Center.
Gan To Kagaku Ryoho. 2023 Mar;50(3):354-356.
The patient was an 80s woman. She visited our hospital with chief complaint of melena, and further evaluation revealed anal canal cancer. We performed robot-assisted abdominoperineal resection(D3 lymphadenectomy)and lateral lymph node dissection. The pathological diagnosis was anal canal cancer, muc>por1>tub2, T3N1bM0, pStage Ⅲb. One year after the surgery, she had a mass in the soft tissue of perineum on CT scan and PET-CT showed abnormal accumulation, which was diagnosed as local recurrence. At the same time, she also had a mass with abnormal accumulation in ascending colon, and it was diagnosed as ascending colon cancer. In both cases, we judged radical resection was possible, and the policy of surgery was decided. First, laparoscopic ileocecal resection was performed. The local recurrence lesion became a mass, invading the soft tissue of the perineum, the posterior wall of the vagina, and the cervix. So, we performed laparoscopic excision of local recurrent region together with the uterus and the posterior wall of the vagina. Based on the result of pathological examination, the patient was diagnosed with ascending colon cancer(tub1, pT1bN1aM0, pStage Ⅲa), and recurrence of anal canal cancer. The postoperative course is good and there are no signs of recurrence for 6 months after the operation.
患者为一名80多岁的女性。她因黑便为主诉前来我院就诊，进一步检查发现肛管癌。我们进行了机器人辅助腹会阴联合切除术（D3淋巴结清扫）及侧方淋巴结清扫。病理诊断为肛管癌，黏液性腺癌>低分化腺癌>管状腺癌，T3N1bM0，pⅢb期。术后一年，她的会阴软组织在CT扫描时有肿物，PET-CT显示有异常浓聚，诊断为局部复发。同时，她升结肠也有一个肿物伴异常浓聚，诊断为升结肠癌。对于这两种情况，我们判断可行根治性切除，并决定了手术方案。首先进行了腹腔镜回盲部切除术。局部复发灶形成肿物，侵犯会阴软组织、阴道后壁及宫颈。因此，我们进行了腹腔镜下局部复发区域连同子宫及阴道后壁的切除。根据病理检查结果，患者被诊断为升结肠癌（管状腺癌，pT1bN1aM0，pⅢa期）及肛管癌复发。术后病程良好，术后6个月无复发迹象。
