Annals of Coloproctology

Original Articles

Trans-Sacral Local Resection as a Posterior Approach.: Lee, Bong Hwa , Park, Hyoung Chul , Lee, Hae Wan , An, Chang Nam , Um, Taeik , Lim, Young A , Kim, Byoung Sup , Chang, Mi Young , Kim, Soo Hyoung , Cho, Sung Wook; J Korean Soc Coloproctol. 2010;26(3):197-203.; DOI: https://doi.org/10.3393/jksc.2010.26.3.197

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PURPOSE
Surgical removal for a mass in the pre-sacral space or mid rectum through a posterior approach is not frequent. We would like to present the technique of trans-sacral local resection as a posterior approach. We analyzed the follow up of patients who underwent surgery using the proposed technique.
METHODS
A total of 21 patients who had undergone a trans-sacral local resection with lower sacrectomy between January 1997 and December 2006 were enrolled in this study. The diagnoses were large epidermal cyst, gastrointestinal stromal tumor, high grade adenoma, and early cancers in the mid rectum. We analyzed the surgical complications and disease recurrences. The mean follow up for tumors of the rectum was 53+/-35 mo.
RESULTS
Epidural anesthesia was appropriate for all whole procedures. Among the 21 cases, there was one case of a rectocutaneous fistula as a postoperative complication (4.9%). In one case among the submucosal cancers, there was a systemic metastasis at 24 mo without local recurrence.
CONCLUSION
In our experience, a trans-sacral resection with a lower sacrectomy is a good option and provides a wide and direct surgical exposure for the removal of a pre-sacral or a mid-rectal mass. Good bowel preparation is mandatory.

Citations

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How to Treat Retrorectal Cysts or Tumors in Adult
Bong Hwa Lee, Hyoung Chul Park, Byung Seup Kim
Journal of the Korean Society of Coloproctology.2011; 27(6): 276. CrossRef

Feasibility of York-Mason Operation for Selective Advanced Rectal Cancer.: Jeong, Woon Kyung , Baek, Seong Kyu , Bae, Ok Suk; J Korean Soc Coloproctol. 2009;25(3):178-185.; DOI: https://doi.org/10.3393/jksc.2009.25.3.178

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Abstract PDF

PURPOSE
The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers.
METHODS
From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively.
RESULTS
The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%).
CONCLUSION
The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.

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Trans-Sacral Local Resection as a Posterior Approach
Bong Hwa Lee, Hyoung-Chul Park, Hae Wan Lee, Chang Nam An, Taeik Um, Young A Lim, Byoung Sup Kim, Mi Young Chang, Soo Hyoung Kim, Sung Wook Cho
Journal of the Korean Society of Coloproctology.2010; 26(3): 197. CrossRef

Local Excision for Rectal Cancer.: NamGung, Hwan , Yu, Chang Sik , Kim, Hee Cheol , Cho, Young Kyu , Ryu, Jang Hak , Cho, Moon Kyung , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):305-310.

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Abstract PDF: PURPOSE
Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological out comes after local excision for rectal cancers.
METHODS
We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58+/-11 years and median follow up period was 24 (range: 1-82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%).
RESULTS
The distance from the anal verge was 5.9+/-2.6 cm and the mean tumor size was 2.5+/-2.0 cm. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73% and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection.
CONCLUSION
Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.

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