A Case of Laparoscope-assisted Total Pelvic Exenteration after Multimodal Treatment for Anal Canal Adenocarcinoma with Proximal Intramural Spread

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  • 集学的治療後に腹腔鏡下骨盤内臓全摘術を施行したproximal intramural spreadを伴った肛門管腺癌の1例

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<p>A 46-year-old man visited our hospital with the chief complaint of a fever of 38.7°C. He thought that the cause was a mass in the right inguinal region that had appeared 6 months earlier and increased thereafter. Excisional biopsy resulted in a diagnosis of lymph node metastasis derived from colorectal cancer. The case was diagnosed as anal canal adenocarcinoma upon close examination. In addition to direct invasion to the lower prostate, lymph node metastases were found in the left inguinal region. The case was diagnosed as Stage IVa (T4bN1aM1a) according to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (9th edition). Colonoscopy showed proximal intramural spread in three parts, which was a rare clinical feature. The patient was treated with chemotherapy and follow-up colonoscopy showed that the lesion had shrunk and CT demonstrated no metastases to distant organs. Laparoscope-assisted total pelvic exenteration was performed after preoperative chemoradiotherapy. The patient was discharged without any serious complications after surgery. The pathological results revealed that the cancer, which seemed to have invaded deeply, had disappeared. Moreover, intramural spread had also disappeared. The histological criterion for assessing the response to chemotherapy/radiotherapy was Grade 2.</p>

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