Department of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China.
Department of Urology, Changzheng Hospital, Navy Medical University, Shanghai, China.
Ann Surg Oncol. 2024 Nov;31(12):7796-7797. doi: 10.1245/s10434-024-16028-8. Epub 2024 Aug 12.
Synchronous rectal and prostate malignancies are rare and standard treatment guidelines have not yet been established. Combined robotic rectal and prostate surgery represents a potentially excellent approach for managing synchronous rectal and prostate malignancies, offering the advantages of a minimally invasive procedure. METHODS: A 78-year-old male with a history of hypertension and type 2 diabetes presented with 3 months of dyschezia and dysuria. Diagnostic colonoscopy revealed a submucosal mass 3 cm from the anal verge in the anterior wall of the rectum, with abnormal carcinoembryonic antigen and prostate-specific antigen levels. Pelvic computed tomography (CT) indicated indistinct boundaries between the rectal mass and the prostate, suggesting potential invasion. CT-guided biopsies confirmed a rectal gastrointestinal stromal tumor (GIST) and prostatic acinar adenocarcinoma. After 3 months of neoadjuvant therapy with imatinib mesylate and bicalutamide, significant tumor reduction was achieved. Subsequently, the patient underwent simultaneous robotic sphincter-preserving rectal resection and prostatectomy, starting with the prostatectomy, followed by rectal tumor excision and ending with bowel reconstruction and vesicourethral anastomosis using a running suture technique.
The operation time was 220 min and the estimated blood loss was 50 mL. No surgical complications were encountered and all resected margins were free of tumor, indicating a complete excision. The patient recovered well and was discharged on the seventh postoperative day. Follow-up at 3 months showed no evidence of recurrence or functional impairments.
Simultaneous robotic sphincter-preserving local rectal resection and prostatectomy can be feasibly and safely performed following neoadjuvant therapy in cases of synchronous rectal GIST and prostate cancer.
直肠和前列腺同时发生恶性肿瘤较为罕见，目前尚未制定标准的治疗指南。机器人辅助同时进行直肠和前列腺切除术为治疗直肠和前列腺同时发生恶性肿瘤提供了一种潜在的优秀方法，具有微创的优势。
一位 78 岁男性，有高血压和 2 型糖尿病病史，因 3 个月排便困难和排尿困难就诊。诊断性结肠镜检查显示直肠前壁距肛门 3cm 处有一黏膜下肿块，癌胚抗原和前列腺特异性抗原水平异常。盆腔 CT 提示直肠肿块与前列腺之间界限不清，提示可能有侵犯。CT 引导下活检证实为直肠胃肠道间质瘤（GIST）和前列腺腺癌。经过 3 个月的甲磺酸伊马替尼和比卡鲁胺新辅助治疗，肿瘤明显缩小。随后，患者接受了同时进行的机器人保留肛门直肠切除术和前列腺切除术，首先进行前列腺切除术，然后切除直肠肿瘤，最后采用连续缝合技术进行肠重建和尿道膀胱吻合。
手术时间为 220 分钟，估计失血量为 50 毫升。无手术并发症，所有切除边缘均无肿瘤，提示完全切除。患者恢复良好，术后第 7 天出院。术后 3 个月随访未见复发或功能障碍。
新辅助治疗后，可行且安全地同时进行机器人辅助保留肛门的局部直肠切除术和前列腺切除术治疗直肠 GIST 和前列腺癌同时发生。
