Multi-disciplinary Treatment of Cancer

Neoadjuvant Chemoradiation followed by surgery saved elderly gentleman's sphincter

Dr. Pankaj Kumar Pande

Dr. Pankaj Kumar Pande
Sr. Consultant
Surgical Oncology
BLK Cancer Centre
BLK Super Speciality Hospital

BLK Pulse

“There is evidence that pre-operative Chemoradiation by downstaging and downsizing the tumour benefits sphincter preservation.”

The aim of treating Rectal Cancer is to have a good regional control with improvement in overall disease-free survival. Distal third Rectal Cancers were traditionally treated with Abdominoperineal Resection. The sphincter-saving procedures have been increasing owing to advances in better surgical techniques and instruments, introduction of multidisciplinary approach (pre-op Chemoradiation - CT / RT), specialised high volume centres and improved understanding of sphincter mechanism and the tumour biology.

THE CASE

A 68-year-old gentleman had a history of bleeding rectum and was also experiencing change in bowel habits for the past one year. Close examination revealed a fungating mass 3-4 cm from anal verge with good sphincter tone, Colonoscopy of the patient revealed eccentric passable fungating mass 3 cm from anal canal and MRI revealed a T3 tumour with mesorectal stranding and nodes.

THE PROCEDURE

He received pre-op RTCT (50.4Gy+ oral capecitabine tablet). Response assessment 6 weeks later revealed reduction in size, bulk of tumour and complete resolution of mesorectal nodes with residual eccentric mural thickening in lower rectum. The patient was counselled for APR with permanent stoma / low anterior resection with temporary Ileostomy. He successfully underwent Laparoscopic assisted low anterior resection with covering Ileostomy. Histopathology revealed moderately differentiated adenocarcinoma with 1 cm distal margins and negative nodes.

THE RESULT

With multidisciplinary approach - Neoadjuvant Chemoradiation, followed by surgery, patient's sphincter was preserved which otherwise would have ended with APR and permanent Colostomy. He is now receiving Adjuvant Chemotherapy to complete the protocolised treatment followed by Ileostomy closure.