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Endo Y, Fukuoka T, Ozawa S, Ishidate T, Yonemitsu K, Seki Y, Kasashima H, Miki Y, Yoshii M, Tamura T, Shibutani M, Toyokawa T, Lee S, Maeda K. Successful resection of a rectal gastrointestinal stromal tumor using a transperineal approach: a case report. Surg Case Rep 2024; 10:213. [PMID: 39254811 PMCID: PMC11387563 DOI: 10.1186/s40792-024-02007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 08/22/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Rectal gastrointestinal stromal tumors (GISTs) complicate surgical approaches because of their anatomical position. We herein report a patient with rectal GIST on the anterior wall of the lower rectum, hat was successfully resected using a transperineal approach. CASE PRESENTATION This report describes a unique case of a 73-year-old man who was diagnosed with rectal GIST on the anterior wall of the lower rectum. The tumor was located within 3 cm of the anal verge, a location that would require highly invasive surgery. A transperineal approach was planned to preserve the anal function. Under general anesthesia, the patient was placed in a lithotomy position and a Mercedes-Benz incision was made in the perineum. Excision of the tumor was performed. The post-operative course was uneventful, and the patient remained free from recurrence. CONCLUSION This case highlights the importance of performing minimally invasive and safe surgery. With some surgical refinements, a transperineal approach may be an option for surgical procedures in patients with rectal GIST on the anterior wall of the lower rectum.
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Affiliation(s)
- Yoki Endo
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan.
| | - Shintaro Ozawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Takemi Ishidate
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Ken Yonemitsu
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Yuki Seki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka City, Osaka, 545-8586, Japan
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Hatai S, Nagai S, Yoshida T, Matsuoka M, Shinkawa T, Oyama Y, Tanabe Y, Kitahara D, Tamiya S, Amada S, Nishihara K, Nakano T. Transvaginal resection of a gastrointestinal stromal tumor of the rectum: a case report. Surg Case Rep 2024; 10:150. [PMID: 38886293 PMCID: PMC11183011 DOI: 10.1186/s40792-024-01949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The most common curative treatment for gastrointestinal stromal tumors (GISTs) is local excision. For rectal GISTs, however, local excision is difficult because of the anatomical features of the rectum. The optimal surgical approach is still under debate, and less invasive methods are desired. We herein report a case of transvaginal resection of a rectal GIST in a young woman. CASE PRESENTATION A 21-year-old woman was diagnosed with a resectable GIST in the anterior rectal wall and underwent transvaginal tumor resection. The posterior vaginal wall was incised, revealing the tumor fully covered by the rectal mucosa. The rectal adventitia and muscular layer were incised, and the tumor was resected en bloc without rupture. The postoperative course was favorable, and the patient was discharged on postoperative day 12. No findings consistent with recurrence were present 6 months postoperatively. CONCLUSION Transvaginal tumor resection is a treatment option as a minimally invasive procedure for GISTs in the anterior rectal wall in female patients.
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Affiliation(s)
- Sanshiro Hatai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shuntaro Nagai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan.
| | - Taiki Yoshida
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Masaru Matsuoka
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Tomohiko Shinkawa
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yasuhiro Oyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yoshitaka Tanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Daichi Kitahara
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Satoshi Amada
- Department of Obstetrics and Gynecology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
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Matsuhashi N, Takahashi T, Ichikawa K, Tanahashi T, Sasaki Y, Tanaka Y, Okumura N, Yamaguchi K, Osada S, Yoshida K. Transvaginal resection of a rectal leiomyoma: A case report. Oncol Lett 2015; 10:3785-3788. [PMID: 26788208 DOI: 10.3892/ol.2015.3816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 07/30/2015] [Indexed: 11/05/2022] Open
Abstract
The present study reports the case of a patient with a rectal submucosal tumor (leiomyoma) that was resected transvaginally. A 51-year-old female presented with a rectal submucosal tumor on the anterior wall of the lower rectum, located within 3 cm of the anal verge. This location would normally require intersphincteric or abdominal perineal resection. However, in order to minimize the invasiveness of the treatment and reduce post-operative morbidity, transvaginal resection and laparoscopic diverting ileostomy were performed instead. With the patient under general anesthesia, the posterior vaginal mucosa was incised vertically. The tumor was then excised en bloc with the overlying rectovaginal septum and rectal submucosal tumor. A primary repair of the defect and a diverting stoma were performed. The procedure did not present any complications, and the patient was discharged on day 10 post-surgery. The diverting stoma was closed 3 months later, and the sphincter function of the patient following surgery was monitored by manometry. The results of the manometric tests indicated that the patient did not suffer from fecal incontinence. In addition, the patient did not experience anal dysfunction or discomfort following the surgical procedure.
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Affiliation(s)
- Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Kengo Ichikawa
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Toshiyuki Tanahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Yoshiyuki Sasaki
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Kazuya Yamaguchi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Shinji Osada
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan
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Sun LF, He JJ, Yu SJ, Xu JH, Wang JW, Li J, Song YM, Ding KF, Zheng S. Transsacral excision with pre-operative imatinib mesylate treatment and approach for gastrointestinal stromal tumors in the rectum: A report of two cases. Oncol Lett 2014; 8:1455-1460. [PMID: 25202349 PMCID: PMC4156190 DOI: 10.3892/ol.2014.2406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/15/2014] [Indexed: 12/29/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare in the rectum. Radical surgery, such as an abdominoperineal resection, is necessary for large rectal GISTs, which can result in the loss of function of involved organs. Imatinib mesylate can be used as perioperative therapy and may reduce tumor size, and it is now approved for use in the adjuvant therapy of locally resected anorectal GISTs. The present study describes two cases of large rectal GISTs, for which abdominoperineal resections were initially planned. The two patients received pre-operative imatinib mesylate treatment, and the therapeutic response was assessed by magnetic resonance imaging. Finally, transsacral local resection was successfully performed for these two GISTs. A macroscopically complete resection was achieved, and microscopically, the resection margin was negative. One patient experienced the complication of rectal leakage, which was successfully managed by drainage. No recurrence occurred in the two patients after more than two years. Pre-operative imatinib mesylate therapy with subsequent transsacral local resection for selected rectal GISTs is a feasible treatment modality and can prevent extended surgery.
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Affiliation(s)
- Li-Feng Sun
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jin-Jie He
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Shao-Jun Yu
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jing-Hong Xu
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jian-Wei Wang
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jun Li
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yong-Mao Song
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Ke-Feng Ding
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Shu Zheng
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Transvaginal resection of a rectal gastrointestinal stromal tumor. Surg Today 2012; 42:909-12. [DOI: 10.1007/s00595-012-0215-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 10/11/2011] [Indexed: 01/04/2023]
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Han SL, Zeng QQ, Shen X, Zheng XF, Guo SC, Yan JY. The indication and surgical results of local excision following radiotherapy for low rectal cancer. Colorectal Dis 2010; 12:1094-8. [PMID: 19863609 DOI: 10.1111/j.1463-1318.2009.02078.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Radical surgery of rectal cancer is associated with significant morbidity, and some patients with low-lying lesions must accept a permanent colostomy. The objective of this study was to evaluate the outcome of local excision followed by adjuvant radiotherapy for rectal cancer for curative purposes. METHOD One hundred and seven patients with rectal carcinoma performed with local excision were analysed retrospectively. RESULTS The procedures of local excision were trans-anal resection in 83 patients, trans-sacral resection in 16, trans-sphincteric local resection in five, and trans-vaginal resection in three. The overall disease-free survival rate was 80.4% (86/107), including 90.0% (54/60) for T1 and 72.3% (34/47) for T2 tumours, respectively. Eighty-two of 107 patients underwent adjuvant postoperative radiotherapy after local excision, and 25 did not, and the DFS rates between radiation and nonradiation group were significantly different for T2 [81.6% (31/38) vs 33.3% (3/9), P < 0.05], but not for T1 tumours (90.9%vs 87.5%, P > 0.05). The rates of local recurrence and distant metastasis were 13.1% (14/107) and 4.7% (5/106), respectively, and the median time to relapse was 15 months (range: 10-53) for local recurrence and 30 months (21-65) for distant recurrence. The risk factors for local recurrence were large tumour (≥3 cm), poorly differentiated adenocarcinoma and T2 tumour. CONCLUSIONS Local excision followed adjuvant radiotherapy is an alternative and feasible technique for small T1 rectal cancer in selected cases.
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Affiliation(s)
- S-L Han
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou City, Zhejiang Province, China.
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Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs), the specific kit-positive mesenchymal tumors of the gastrointestinal tract, are rarely found in the anorectum and account for only 0.1% of all colorectal tumors. The main stem of therapy remains surgical excision. The standard surgical approach for anorectal GISTs includes transanal resection or enucleation for smaller and anterior or abdominoperineal resection for larger tumors. METHODS We present an alternative, transvaginal approach for a local excision of a large rectal GIST. In our case, a 5 x 5 x 8 cm large GIST located 3 cm above the dentate line in the anterior rectal wall was removed through the vagina. RESULTS In our experience, this approach enables a safe alternative even for larger tumors in the anterior rectal wall with a very low morbidity, sparing the patient from an unnecessary abdominoperineal resection.
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Affiliation(s)
- Minia Hellan
- University of Illinois in Chicago-Metropolitan Group Hospitals Residency in Surgery, 836 W. Wellington Ave., Chicago, IL, USA
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