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Laparoscopic abdominosacral resection for rectal and anal canal carcinoma with pagetoid spread
Author(s) -
Hondo Nao,
Miyagawa Yusuke,
Kitazawa Masato,
Muranaka Futoshi,
Tokumaru Shigeo,
Koyama Makoto,
Takahata Shugo,
Soejima Yuji
Publication year - 2021
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12856
Subject(s) - medicine , lithotomy position , abdominoperineal resection , surgery , rectum , colorectal surgery , resection margin , pagetoid , laparoscopic surgery , colorectal cancer , laparoscopy , resection , cancer , abdominal surgery , melanoma , alternative medicine , pathology , cancer research
Perianal Paget's disease is associated with adenocarcinoma and can spread to the perianal skin. It often requires extensive resection of the perianal skin and rectum. Many studies have shown the efficacy of laparoscopic abdominoperineal resection for lower rectal cancer. However, extensive resection of the dorsal side of the perineal skin is difficult in the lithotomy position. We report a laparoscopic abdominosacral approach using the jackknife position for perianal Paget's disease. Materials and Surgical Technique Surgery was started using the lithotomy position, and total mesorectal excision with central lymphadenectomy was performed laparoscopically. Pelvic floor muscles were divided 2 cm away from the rectum. The sigmoid colon was then divided with a linear stapler, and a terminal colostomy was made. The sacral approach was then followed with the patient placed in a jackknife position. A skin incision was made 1‐2 cm from the negative margin confirmed by preoperative mapping biopsy and resected en‐bloc. We used this approach in two patients with a mean operative time of 483 minutes, including 53.5 minutes for the position change. All tumor margins, including the skin, were cancer‐free, and primary wound closure was possible in both of the cases. Both patients were doing well without any recurrence 10 and 13 months postoperatively. Conclusion Laparoscopic abdominosacral resection is safe and effective and facilitates extensive perineal skin resection, especially on the dorsal side, with a less invasive laparoscopic procedure.