Laparoscopic abdominosacral resection for rectal and anal canal carcinoma with pagetoid spread

Abstract

Introduction 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.

A Case of Prostatic Signet-Ring Cell-like Carcinoma with Pagetoid Spread and Intraductal Carcinoma and Long-Term Survival: PD-L1 and Mismatch Repair System Proteins (MMR) Immunohistochemical Evaluation with Systematic Literature Review

“…The differential diagnosis of PS from PA includes urothelial or colorectal carcinomas displaying PS to prostatic ducts and seminal vesicles [ 48 , 49 , 50 ] and intraepithelial pagetoid histiocytes [ 51 ]. In our case, the pagetoid intraepithelial cells showed high-grade atypia and expressed prostatic immunomarkers (PSA, PSAP, P504S), while the urothelial (GATA-3, CK34βE12), colorectal (CK20, CDX-2, CK7) and histiocytic (CD68) immunostains were negative.…”