Para‐sacral approach followed by laparoscopic low anterior resection of a gastrointestinal stromal tumour at the anterior wall of the lower rectum
- 22 February 2021
- journal article
- research article
- Published by Wiley in Colorectal Disease
- Vol. 23 (6), 1579-1583
- https://doi.org/10.1111/codi.15597
Abstract
Aim We present a para‐sacral approach followed by a laparoscopic low anterior resection of gastrointestinal stromal tumours located between the urethra and the low rectum. Method Case 1 is a 56‐year‐old male patient whose tumour (37 × 28 mm) was located 3.0 cm above the anal verge between the anterior wall of the rectum and the urethra; he underwent surgery after 14 months’ administration of imatinib mesylate (400 mg/day). Case 2 is a 68‐year‐old male patient who presented with dysuria; a tumour (89 × 84 mm) was detected between the urethra and the anterior wall of the low rectum by MRI. He underwent surgery after 5 months’ administration of imatinib mesylate (400 mg/day). In order to perform sphincter‐preserving surgery and avoid injury not only to the tumour capsule but also to the urethra, a para‐sacral approach followed by laparoscopic low anterior resection was adopted in these patients. Restoration of bowel continuity was done by coloanal anastomosis in case 1 and the double stapling technique in case 2. The postoperative course of the patients was uneventful. In case 2, tumour dissection from the urethra caused injury to the posterior wall of the urethra, which could be repaired easily under direct vision. The urethral catheter was removed after 117 postoperative days, and the diverting stoma was closed after 143 postoperative days. Conclusion The para‐sacral approach followed by a laparoscopic low anterior resection of an extraluminal gastrointestinal stromal tumour located between the urethra and anterior wall of the low rectum enables R0 resection of the tumour and an appropriate reconstruction of the rectum.This publication has 10 references indexed in Scilit:
- Diagnosis and Treatment of Rectal Gastrointestinal Stromal TumorsDiseases of the Colon & Rectum, 2019
- Para-sacral approach for large gastrointestinal stromal tumor of the lower rectumInternational Cancer Conference Journal, 2017
- Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapyMedicine, 2017
- Surgery beyond the visible light spectrum: theoretical and applied methods for localization of the male urethra during transanal total mesorectal excisionTechniques in Coloproctology, 2017
- Fluorescence to highlight the urethra: a human cadaveric studyTechniques in Coloproctology, 2017
- Laparoscopic Local Excision and Rectoanal Anastomosis for Rectal Gastrointestinal Stromal TumorDiseases of the Colon & Rectum, 2014
- Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal tumours after treatment with imatinibEuropean Journal of Surgical Oncology, 2013
- Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology, 2012
- Trans‐sacral (Kraske) approach for gastrointestinal stromal tumour of the lower rectum: old procedure for a new diseaseColorectal Disease, 2008
- Transvaginal excision of a large rectal stromal tumor: an alternativeThe American Journal of Surgery, 2006