ANASTOMOTIC RECURRENCE AFTER 1/3-YEAR RECTAL NEOPLASM OPERATED WITH PRESERVATION OF THE ANAL SPHINCTER

Abstract

The quality of surgery, the limits of resection, the total excretion of "mesorectum", mechanical or manual anastomosis and pre-and postoperative oncologic treatment of rectal cancer, all these, may influence the incidence of local recurrence. We have analyzed the case of a 62-year old patient with rectal bleeding , diarrhea, and rectal tenesmus. The colonoscopy revealed a rectal tumor located at 10 cm from anal-rectal limit. A biopsy was taken from the tumor: moderately differentiated adenocarcinoma. CEA and CA19.9 tumor markers were found within normal limits. There was performed rectal resection with end-to-end colonic – rectal anastomosis with Stapler 32. Postoperatively, pathological examination: rectal adenocarcinoma NOS with low degree of malignancy G2 – moderately differentiated, diffuse infiltration to the musculature, without metastasis in regional nodes (only identified 5), completely excised surgically – it was classified as pT2pNo (G2) stage. Postoperatively, the patient did not perform oncology treatment. Colonoscopy which was performed 1 year after surgery, revealed a bleeding tumor located at the anastomosis level. Biopsies were taken from the anastomosis tumor. The result confirms the local recurrence of invasive adenocarcinoma. Milles rectum amputation is decided and practiced. Postoperatively the patient performs oncological treatment. Preoperative staging is an important factor in determining the indication of radiotherapy.

Keywords

• anastomosis recurrence
• excision of mesorectum
• radiotherapy