Outcomes of surgical treatment in patients with anorectal fistula cancer

Osone, Katsuya; Ogawa, Hiroomi; Katayama, Chika; Shibasaki, Yuta; Suga, Kunihiko; Komine, Chika; Ozawa, Naoya; Okada, Takuhisa; Shiraishi, Takeshi; Katoh, Ryuji; Sakai, Makoto; Sano, Akihiko; Yokobori, Takehiko; Matsumura, Nozomi; Sohda, Makoto; Shirabe, Ken; Saeki, Hiroshi

doi:10.1186/s40792-021-01118-6

Cited by 5 publications

(5 citation statements)

References 15 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our patient, the fistula had been present for 4 years and there was no tumor present in the rectal mucosa. The authors of other studies in the literature have reported a varied time period between the onset of a fistula and its presentation as a malignant lesion (Table 1) [4][5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature

Ghosh,

Kumar

2024

Ann Coloproctol

View full text Add to dashboard Cite

The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature

Ghosh,

Kumar

2024

Ann Coloproctol

View full text Add to dashboard Cite

show abstract

“…To the best of our knowledge, this is the first report of implantation metastasis to an anal fistula after neoadjuvant therapy for rectal cancer in a patient without a history of anal fistula. Persistent anal fistulas with recurrent inflammation are known risk factors for primary cancer [ 13 ]. Furthermore, when colorectal cancer spreads to the anal fistula, cancer cells shedding into the intestinal lumen are implanted in the injured mucosa [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

et al. 2022

View full text Add to dashboard Cite

Background Anal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion. Case presentation A 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor’s partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery. Conclusions This is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.

show abstract

“…Of the three patients that underwent preoperative HRCT, two were successful in downstaging their tumors and all three achieved R0 resection. 30 Few reviews looking at outcomes on treatment provide information on whether immunosuppressant medications were continued during treatment. In one case report, the treating group continued the patient's TNF-α inhibitor through neoadjuvant therapy before ultimately stopping the medication prior to undergoing APR for mucinous adenocarcinoma.…”

Section: Treatmentmentioning

confidence: 99%

“…10 Similarly, a study evaluating surgical outcomes at a single institution in patients undergoing oncologic resection of FAAC noted that the use of a preoperative hyperthermochemoradiotherapy (HRCT) regimen was effective in downstaging tumors and may have played a role in successful R0 resection. 30 This regimen consisted of 50 Gy over daily 2 Gy fractions on 5 consecutive days per week. Capecitabine was given daily on radiation days for the 5 weeks of treatment.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Cancer in Anal Fistulas

Perez

Eisenstein

2023

Clin Colon Rectal Surg

View full text Add to dashboard Cite

Fistula-associated anal cancer in Crohn's disease (CD) can be challenging to diagnose and treat. Patients with longstanding fistulas in the setting of CD who present with a sudden change in their symptoms should undergo biopsy under anesthesia with extensive sampling, followed by staging imaging. Pelvic magnetic resonance imaging (MRI) can be helpful in identifying the extent of the disease locally. Patients often present in the later stages due to the challenges associated with diagnosing these patients. Two subtypes of this disease include squamous cell carcinoma and adenocarcinoma, and treatment depends on diagnosis. Small sample size and lack of uniform data on treatments make it difficult to say which treatment modalities are optimal, but aggressive combined therapy is likely the best approach for survival. This will include chemotherapy and radiation and often radical resection as well. Despite this, survival is poor, although more recent data suggest that outcomes are improving.

show abstract

Outcomes of surgical treatment in patients with anorectal fistula cancer

Cited by 5 publications

References 15 publications

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

Cancer in Anal Fistulas

Contact Info

Product

Resources

About