Local Recurrence after Abdominoperineal Resection with Vertical Rectus Abdominis Musculocutaneous Flap:A Case Report of Pelvic Exenteration with Preservation of the Flap

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  • Murata Yuki
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Uehara Kay
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Ogura Atsushi
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Aiba Toshisada
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Mishina Takuya
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Kambara Yuichi
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Suzuki Yumi
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine
  • Ebata Tomoki
    Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine

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  • 有茎腹直筋皮弁を用いた会陰再建後に筋皮弁温存骨盤内臓全摘術を施行した1例

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Abstract

<p>A 75-year-old man underwent abdominoperineal resection （APR） and reconstruction using a right vertical rectus abdominis musculocutaneous （VRAM） flap for fistula-associated anal cancer 1 year ago. Pathological findings revealed mucinous adenocarcinoma （T4N0M0） with R1 resection. Six months after surgery, local recurrence developed and he was referred to our hospital. CT findings showed that the recurrent tumor, 30 mm in diameter, was adjacent to the right side of the prostate and the ventral side of the VRAM flap, however, there was no finding of invasion of the feeding vessels.</p><p>Total pelvic exenteration （TPE） with preservation of the VRAM flap was successfully performed. He was discharged on the 27th day after surgery and remains alive without recurrence 1 year after surgery.</p><p>The VRAM flap has been widely used in perineal reconstruction after extended pelvic surgery. In the case of local recurrence thereafter, redo surgery may be complicated, especially when the flap should be preserved. In this case, fortunately we could achieve R0 resection, however, preservation sometimes threatens curability, therefore, the indication should be carefully considered.</p>

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