Feitosa MR, de Freitas LF, Filho AB, Nakiri GS, Abud DG, Landell LM, Brunaldi MO, da Rocha JJR, Feres O, Parra RS. Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision: A case report. World J Clin Oncol 2020; 11(12): 1070-1075 [PMID: 33437668 DOI: 10.5306/wjco.v11.i12.1070]
Corresponding Author of This Article
Rogério Serafim Parra, MD, PhD, Staff Physician, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, No. 3900 Av. Bandeirantes, Ribeirão Preto 14048900, São Paulo, Brazil. rsparra@hcrp.usp.br
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Dec 24, 2020; 11(12): 1070-1075 Published online Dec 24, 2020. doi: 10.5306/wjco.v11.i12.1070
Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision: A case report
Marley Ribeiro Feitosa, Lucas Fernandes de Freitas, Antonio Balestrim Filho, Guilherme Seizem Nakiri, Daniel Giansante Abud, Ligia Magnani Landell, Mariângela Ottoboni Brunaldi, Jose Joaquim Ribeiro da Rocha, Omar Feres, Rogério Serafim Parra
Marley Ribeiro Feitosa, Lucas Fernandes de Freitas, Antonio Balestrim Filho, Jose Joaquim Ribeiro da Rocha, Omar Feres, Rogério Serafim Parra, Department of Surgery and Anatomy, Medicine School of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048900, São Paulo, Brazil
Guilherme Seizem Nakiri, Daniel Giansante Abud, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048900, São Paulo, Brazil
Ligia Magnani Landell, Mariângela Ottoboni Brunaldi, Department of Pathology and Forensic Medicine, Medicine School of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048900, São Paulo, Brazil
Author contributions: Feitosa MR and Parra RS designed the study, collected data, analyzed and interpreted the data, drafted and revised the manuscript; de Freitas LF, Filho AB and Abud DG collected data, analyzed and interpreted the data; Nakiri GS, da Rocha JJR and Feres O analyzed and interpreted the data, and revised the manuscript; Brunaldi MO prepared the images, and performed data analysis and interpretation; all authors contributed to the analysis and interpretation of the data, revision of the manuscript for important intellectual content, granted final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Informed consent statement: All authors carefully protected the patient’s anonymity. The patient signed an informed consent allowing the publication of this case report and any other related publication.
Conflict-of-interest statement: The authors report no conflict of interest.
CARE Checklist (2016) statement: We have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rogério Serafim Parra, MD, PhD, Staff Physician, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, No. 3900 Av. Bandeirantes, Ribeirão Preto 14048900, São Paulo, Brazil. rsparra@hcrp.usp.br
Received: July 16, 2020 Peer-review started: July 16, 2020 First decision: August 7, 2020 Revised: August 20, 2020 Accepted: October 20, 2020 Article in press: October 20, 2020 Published online: December 24, 2020 Processing time: 149 Days and 1.3 Hours
Abstract
BACKGROUND
Abdominoperineal excision (APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss. The objective of the present study was to demonstrate the use of preoperative embolization (PE) as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding, scheduled for APE.
CASE SUMMARY
A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus. The patient was diagnosed with bulky adenocarcinoma limited to the rectum. As the patient refused any clinical treatment, surgery without previous neoadjuvant chemoradiation was indicated. The patient underwent a tumor embolization procedure, two days before surgery performed via the right common femoral artery. The tumor was successfully devascularized and no major bleeding was noted during APE. Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.
CONCLUSION
Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses. We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.
Core Tip: Abdominoperineal excision (APE) remains a major surgery with considerable morbidity. Half of patients undergoing APE have some type of postoperative complication, and bleeding requiring transfusion of blood products is the main morbidity of the procedure. Preoperative embolization as a strategy for blood preservation in a giant rectal hemangioma has been successfully described.
