Perineal approach for a gastrointestinal stromal tumor on the anterior wall of the lower rectum
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Perineal approach for a gastrointestinal stromal tumor on the anterior wall of the lower rectum Hiroyuki Kinoshita*, Yoshifumi Sakata, Yasukazu Umano, Hiromitsu Iwamoto and Kazunari Mori
Abstract Background: Wide margins of resection and regional lymphadenectomy for GIST are not necessary. Several procedures for rectal GIST have been designed according to the location and size of the tumor to preserve the anal function and decrease the morbidity rate. Case presentation: We report a 61-year-old-man with rectal bleeding. Proctologic examination revealed a small mass of approximately 2 cm in diameter on the anterior wall of the rectum at a distance of 4 cm from the anal verge. Histological examination of the biopsy sample via the rectum led to a diagnosis of GIST due to immunohistochemical positivity for C117 and CD34. Perineal resection was planned because abdominoperineal resection with sacrificing the sphincter function was excessive for this small tumor, and low anterior resection with the double stapling technique was difficult due to the lower position. A hemispheric incision was made from one mid-ischial tuberosity to the other with an apex of approximately 2 cm above the anus. The fascia band and muscles were successively transected in order to expose the anterior wall of the rectum, and excision of the tumor was performed. The postoperative course was uneventful, and the patient remained free from incontinence and recurrence. Conclusions: This perineal approach for a GIST on the anterior wall of the rectum is one option for preserving the anal function and decreasing the morbidity rate. Keywords: Gastrointestinal stromal tumor, rectum, perineal approach
Background Transanal or transcoccygeal approaches involve common routes for the local excision of rectal tumors. However, these methods are limited to cases of early rectal cancer close to the anal verge without the risk of lymph node metastasis or a non-epithelial tumor at the posterior wall of the rectum. It is difficult to plan the surgical strategy for a gastrointestinal stromal tumor (GIST) at the anterior wall of the lower rectum, as the procedures for the lower rectum are hampered by poor visualization and may cause anal dysfunction or discomfort. Transvaginal excision as described by Hellan is suitable for lesions higher on the anterior wall of the rectum and avoids anal dysfunction [1]. Radical perineal prostatectomy was first described by Young in 1905 [2]. This approach offers a direct route to the apex of the prostate via the external rectal sphincter. We report this method for * Correspondence: [email protected] Department of Surgery, Naga Municipal Hospital, 1282, Uchita, Kinokawa, Wakayama 649-6414, Japan
local excision of a small rectal GIST in a 61-year-old male patient.
Case presentation The patient presented to our hospital with rectal bleeding. He had neither constitutional symptoms nor a history of note. Proctologic examination revealed a small mass of approximately 2 cm in di
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