Abdominotransanal resection of a strangulated rectal carcinosarcoma

Abstract

This is a case of a 75-year-old man who presented with a 7-month history of a reducible rectal mass. The patient came to the emergency department with a prolapsed necrotic bowel involving a strangulated segment with the rectal mass. He underwent an abdominotransanal resection through a combined abdominal and perineal approach. His postoperative course was unremarkable. Histopathological and immunohistochemical studies showed a rectal carcinosarcoma. Because of a state-mandated lockdown due to the COVID-19 pandemic, the patient failed to follow-up. He was later seen to have metastatic progression. Owing to the poor functional status of the patient, the shared decision of the multidisciplinary team, the patient and his family was to manage him with palliative intent.

Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis

“…In our review, males gender predominated development of SARS-CoV-2 illness in CRC patients, a finding suggested in most of the reports [ 9 , 11 , 14 , 16 , 17 , 25 , 27 , 28 , 30 , 32 – 35 , 47 , 52 – 59 , 61 , 62 , 71 , 72 , 74 , 75 , 77 , 81 – 85 ] and in contradiction with data from other reports suggesting an equal proportion of COVID-19 cases in CRC patients for both genders [ 14 , 23 , 29 , 31 , 60 , 80 ] or patients with CRC and SARS-CoV-2 illness were mostly females [ 11 , 36 , 46 , 49 , 50 , 66 , 67 , 76 ]. This review reflects previous studies in showing that the overall incidence of CRC is higher in males than in females [ 99 – 101 ].…”

“…The detailed characteristics of the included studies are shown in Table 1 . There were 16 case report [ 16 , 32 , 46 , 48 – 50 , 52 , 54 , 55 , 59 , 66 , 67 , 71 , 75 , 82 , 84 ], 9 case series, 41 cohort [ 8 – 17 , 23 , 25 , 26 , 29 , 31 , 34 , 43 – 45 , 51 , 53 , 56 – 58 , 60 – 65 , 68 – 70 , 73 , 74 , 77 , 79 , 80 , 83 , 85 ], 2 cross-sectional [ 72 , 76 ] and 1 case–control [ 81 ] studies. These studies were conducted in China ( n = 15), Italy ( n = 8), United States ( n = 6), United Kingdom ( n = 6), Spain ( n = 5), India ( n = 4), France ( n = 3), Turkey ( n = 2), Brazil ( n = 2), Japan ( n = 2), Colombia ( n = 1), Philippines ( n = 1), Poland ( n = 1), Iran ( n = 1), The Netherlands ( n = 1), Belgium ( n = 1), United Arab Emirates ( n = 1), Mexico ( n = 1), Sweden ( n = 1), Austria ( n = 1), Hungary ( n = 1), Australia ( n = 1), and Chile ( n = 1).…”

“…Few studies were made within multi-countries ( n = 3) [ 9 , 12 , 51 ]. The majority of the studies were single centre [ 11 , 16 , 23 , 25 , 27 , 28 , 30 – 35 , 44 – 50 , 52 , 54 , 55 , 58 , 59 , 61 – 63 , 65 – 69 , 71 , 72 , 74 – 76 , 78 , 80 , 82 – 84 ] and only 25 studies were multi-centre [ 8 – 10 , 12 – 17 , 26 , 29 , 36 , 43 , 51 , 53 , 56 , 57 , 60 , 64 , 70 , 73 , 77 , 79 , 81 , 85 ]. The median NOS score for these studies was 6 (range, 5–7).…”

“…The median patient age ranged from 51.6 years to 80 years across studies. There was an increased male predominance in CRC patients diagnosed with SARS-CoV-2 in most of the studies [ n = 2243, 66.7%] [ 9 , 11 , 14 , 16 , 17 , 25 , 27 , 28 , 30 , 32 – 35 , 47 , 52 – 59 , 61 , 62 , 71 , 72 , 74 , 75 , 77 , 81 – 85 ] and majority of the patients belonged to White (Caucasian) ( n = 262, 7.8%), Hispanic ( n = 156, 4.6%) and Asian ( n = 153, 4.5%) ethnicity [ 11 , 13 – 17 , 25 – 34 , 36 , 43 , 44 , 46 – 50 , 52 – 55 , 57 – 61 , 67 , 70 – 73 , 75 – 78 , 80 , 81 , 83 – 85 ]. Most patients were diagnosed for CRC through symptoms, endoscopy, radiological imaging, biopsies and tumor markers [ 8 – 10 , 12 – 14 , 16 , 17 , 23 , 25 – 36 , 43 , 44 , 46 – 56 , 58 – 61 , 65 – 77 ...…”

“…Most patients were diagnosed for CRC through symptoms, endoscopy, radiological imaging, biopsies and tumor markers [ 8 – 10 , 12 – 14 , 16 , 17 , 23 , 25 – 36 , 43 , 44 , 46 – 56 , 58 – 61 , 65 – 77 , 80 – 85 ]. The main source of SARS-CoV-2 infection in CRC patients was community-acquired ( n = 2882, 85.7%; p = 0.014) [ 8 , 11 – 17 , 23 , 28 , 29 , 33 , 34 , 43 – 45 , 48 , 50 , 52 , 55 , 58 , 59 , 62 – 67 , 70 , 71 , 75 , 76 , 81 – 83 ]. Most of those SARS-CoV-2 patients had stage III CRC ( n = 725, 21.6%; p = 0.036) [ 9 , 13 , 17 , 35 , 45 , 72 , 83 ]; and were treated mainly with surgical resections ( n = 304, 9%) and chemotherapies ( n = 187, 5.6%), p = 0.008 [ 9 – 11 , 16 , 17 , 23 , 25 , 26 , 28 , 29 , 31 – 36 , 43 – 45...…”