A Case of Giant Squamous Cell Carcinoma of the Perineum with Invasion to Anus, Rectum and Vagina Successfully resected by Transsacral Approach

Shigeru Kato, Yosuke Kinjo*, Shugen Kan*, Hidekazu Yamamoto* and Jun Takeda*

Department of Surgery, Kyoto University
Department of Surgery, Osaka Prefectural Saiseikai Izuo Hospital*

A 70-year-old woman reporting dyspnea and a perianal tumor she had noted in 2005 but left was admitted in September 2007 for a worsening dyspnea and diagnosed with congestive heart failure due to old myocardial infarction. An eight-centimeter tumor at the perineum that had spread to the anus and vagina proved on biopsy to be squamous cell carcinoma. The tumor had directly invaded the anterior wall of the rectum and the posterior vagina, necessitating rectal amputation with vaginal wall resection to ensure complete tumor resection. Because cardiac function deteriorated and the ejection fraction was only 40%, we selected local transsacral resection as less invasive. With the patient in the jackknife position, we amputated the rectum and resected the tumor with the anus and the posterior wall of the vagina, then set a double-barreled stoma through a small incision. Total operating time was 210 minutes and blood loss was 424 g. Mild pulmonary congestion was observed temporarily after the operation, but she soon recovered. The surgical margin was negative pathologically, and she is doing well without recurrence three months after surgery.

Key words
transsacral approach, rectal amputation, squamous cell carcinoma

Reprint requests
Shigeru Kato Department of Surgery, Kyoto University
54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
September 24, 2008

To read the PDF file you will need Abobe Reader installed on your computer.