Yoshida Yusuke, Teraishi Fuminori, Shoji Ryohei, Matsumi Yuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN.
Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, JPN.
Cureus. 2024 Dec 24;16(12):e76352. doi: 10.7759/cureus.76352. eCollection 2024 Dec.
Rectal gastrointestinal stromal tumors (GISTs) are often asymptomatic and may be detected as giant tumors. This may require highly invasive surgery for radical resection. Here, we describe a 74-year-old man with a locally advanced non-metastatic GIST in the right anterolateral wall of the lower rectum. The tumor was giant (128 × 93 mm), and invasion into adjacent organs (right seminal vesicle and prostate gland) was suspected. Although neoadjuvant chemotherapy (NAC) with imatinib reduced the tumor size, it was still giant, 80 mm in diameter. Therefore, we performed super-low anterior resection using a robot-assisted laparoscopic approach with the transanal approach. The bi-directional approach enabled safe and precise surgery, is expected to increase the rate of anorectal preservation as well as R0 resection, and may prevent a decline in quality of life.
直肠胃肠道间质瘤（GISTs）通常无症状，可能被发现为巨大肿瘤。这可能需要进行高度侵入性的手术以实现根治性切除。在此，我们描述一名74岁男性，其下直肠右前外侧壁存在局部晚期非转移性GIST。肿瘤巨大（128×93毫米），怀疑侵犯相邻器官（右侧精囊和前列腺）。尽管使用伊马替尼进行新辅助化疗（NAC）使肿瘤尺寸缩小，但它仍然很大，直径达80毫米。因此，我们采用机器人辅助腹腔镜联合经肛门入路进行超低位前切除术。这种双向入路实现了安全、精确的手术，有望提高保肛率以及R0切除率，并可能防止生活质量下降。
