Background/Aim: The reported incidence of rectovaginal fistula is very low. Although some case reports have described surgical procedures, no systematic approach to the treatment of rectovaginal fistula according to diagnostic image and colonoscopy findings has been proposed. We present a comprehensive surgical strategy for rectovaginal fistula after colorectal anastomosis according to diagnostic image and colonoscopy findings. Patients and Methods: This retrospective study included 11 patients who developed rectovaginal fistula after colorectal anastomosis. Rectovaginal fistula was classified into 4 types according to contrast enema images and colonoscopy findings, i.e., "Alone type", "Dead space type", "Anastomotic stricture type", and "Dead space and Anastomotic stricture type". The surgical strategies were "Diversion (Stoma)", "Percutaneous drainage", "Anastomotic stricture type", "Endoscopic balloon dilation", "Curettage of foreign bodies", "Simple full-thickness closure", "Split-thickness closure", "Pedicled flaps packing", and "Reanastomosis". The surgical strategy appropriate for each rectovaginal fistula type was investigated. Results: Among "Alone type" cases, 5 (71.4%) healed with "only Diversion (Stoma)". "Alone type" cases (n=11) and all other cases (n=4) healed with "only Diversion (Stoma)" (n=5) or any other method (n=6) (p=0.022). Conclusion: For treatment of rectovaginal fistula after colorectal anastomosis, less invasive treatment approaches should be attempted first.
We report the case of a 77-year-old man who presented to our hospital with cecal cancer, lung metastasis, and liver metastasis in January 2013. After four courses of modified infusional intravenous fluorouracil and levofolinate with oxaliplatin (mFOLFOX 6) + bevacizumab, there was no new metastatic lesion and lung metastasis reduction was observed. Ileocecal resection was performed in May, left lower lung lobectomy in August, and extended right posterior segmentectomy + S8 partial liver resection was performed in December. The tumor marker declined initially;thereafter, it gradually increased. Computed tomography (CT) performed in April 2014 revealed right inguinal mass around the mesh-plug prosthesis. A positron emission tomography-CT (PET-CT) also revealed a high 2-fluoro-2-deoxy-D-glucose (FDG) uptake at the same site. Right inguinal tumor resection was performed in July. Cancer tissues were confirmed by performing intraoperative rapid pathological diagnosis, and R0 resection could be achieved. Previous studies have reported malignant tumor metastases to the mesh-plug prosthesis, and this was believed to one of the sites that cancer cells can easily engraft. In particular, in patients with a history of advanced malignant tumors, if mass formation around the artifact insertion site is observed, the possibility of peritoneal metastasis should be considered. J. Med. Invest. 65:142-146, February, 2018.
Background
Metastatic lateral pelvic nodes represent an important cause of pelvic recurrence in low rectal cancer patients even after preoperative chemoradiotherapy. This study aimed to evaluate the prognostic benefit of an upfront lateral pelvic nodes dissection strategy.
Methods
A total of 175 consecutive patients with stage II/III low rectal adenocarcinoma who underwent mesorectal excision with lateral pelvic nodes dissection between 1998 and 2013 were identified. Regional lateral pelvic nodes were categorized as LD2 nodes (internal iliac, hypogastric and obturator) and LD3 nodes (external iliac, common iliac, lateral sacral, presacral and sacral promontory) according to the current Japanese Society for Cancer of the Colon and Rectum classification.
Results
Five-year cumulative risks of local recurrence and recurrence-free survival were 4.8% and 78.1% for stage II patients, and 11.8% and 61.7% for stage III patients, respectively. Among stage III patients, no differences were observed in cumulative risks of local recurrence (5 years: 9.3% vs 14.7%, P= 0.463) and recurrence-free survival (5 years: 65.1 vs 61.2%, P = 0.890) between lateral pelvic nodes (−) and LD2 (+) patients. In multivariate analyses, metastatic lateral pelvic nodes had no impact on cumulative risks of local recurrence (hazard ratioadj: 1.389; 95% confidence interval: 0.409–4.716) and recurrence-free survival (hazard ratioadj: 0.884; 95% confidence interval: 0.425–1.837).
Conclusions
Metastatic lateral pelvic nodes had no impact on cumulative risks of local recurrence and recurrence-free survival based on an upfront lateral pelvic nodes strategy. Lateral pelvic nodes can improve recurrence and survival outcomes in locally advanced low rectal cancer patients with metastatic lateral pelvic nodes.
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