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We present the case of a 70-year-old male with a presacral tumor known to be recurrent prostate cancer with an operative plan of a low anterior resection versus abdominoperineal resection. Intraoperatively, the presacral tumor was adherent to both the sacrum and rectum. Careful dissection of the tumor off of the sacrum allowed for full mobilization of the colon and rectum, which in turn allowed for a stapled coloanal anastomosis with preservation of the sphincter complex and restoration of function.
The patient is a 70-year-old male who presents with a presacral tumor known to be recurrent prostate cancer. The operative plan was low anterior resection versus abdominoperineal resection. It was undetermined prior to the surgery if resection of the tumor would allow for anastomosis, or if a permanent colostomy was required. Intraoperatively, the tumor was adherent to both the sacrum and rectum. A meticulous and careful dissection of the tumor allowed for a stapled coloanal anastomosis with preservation of the sphincter complex and restoration of function, and a permanent colostomy was avoided.
The patient is a 70-year-old male who presents with a presacral tumor known to be recurrent prostate cancer. The patient had initially undergone radical prostatectomy and radiation therapy in 2008, and has since had chemotherapy, hormonal therapy, and immunotherapy. In 2013, the patient had recurrence of his prostate cancer in the presacral space. The presacral tumor has been resistant to treatment and has continued to grow since then. The patient most recently had external beam radiation therapy. The presacral tumor persisted and so the patient presented for surgical resection of the disease. The operative plan was low anterior resection versus abdominoperineal resection. It was undetermined prior to the surgery if resection of the tumor would allow for anastomosis, or if a permanent colostomy was required. Intraoperatively, the tumor was adherent to both the sacrum and rectum.
Once the presacral space was entered, the mass was encountered in the distal presacral space. The mass was adherent to the rectum and sacrum. The mass was lifted up and off the sacrum with careful meticulous dissection to separate away from the bony structures and mobilized with the capsule mostly intact. The lateral attachments were then taken down on either side. A meticulous and careful dissection of the tumor allowed for a stapled coloanal anastomosis with preservation of the sphincter complex and restoration of function; a permanent colostomy was avoided.
The patient tolerated the procedure well, and three months later continues to do well. The patient recently had a gastrografin enema which revealed no stricture or leak and was subsequently scheduled for ileostomy reversal.
In this case where the presacral tumor was found to be adherent to both the sacrum and rectum, careful and meticulous dissection of the tumor off of the sacrum allowed for full mobilization of the colon and rectum. This in turn allowed for a stapled coloanal anastomosis with preservation of the sphincter complex and restoration of function. This case was characterized by an impressive complexity of the low pelvic dissection, where precise surgical technique was required to preserve the patient's rectum and allow for successful avoidance of a permanent colostomy.
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Review Robotic Ultra-Low Anterior Resection of a Presacral Prostate Cancer Recurrence.