VM35 - Posterior Approach Completion Proctectomy with Left Pedicled Gracilis Myocutaneous Flap Reconstruction for Recurrent Rectal Cancer: A Case Report

ONGOING VIDEOS

Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Basil Karam, MD

Resident
UCSF
San Francisco, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

HC

Hueylan Chern, MD

Professor of Surgery
University of California, San Francisco
San Francisco, California, United States

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This individual has no financial relationships with ineligible companies.

Author(s)

MP

Merisa Piper, MD

Assistant Professor of Surgery
UCSF
San Francisco, California, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Basil Karam, MD: This individual has no financial relationships with ineligible companies.

Hueylan Chern, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Rectal cancer in young people is an increasingly recognized clinical entity, with a rising incidence among individuals under 50 years of age. This demographic often presents with more advanced disease at diagnosis. We discuss here the surgical management of recurrent rectal cancer in a 44 year old woman who initially underwent a lower anterior resection with end colostomy and was later diagnosed with a recurrence in her rectal cuff. We proceeded with a posterior approach completion proctectomy with left pedicled gracilis myocutaneous flap reconstruction.

Methods/Interventions: This surgical procedure was recorded using a GoPro and an iPhone camera. Video editing was done using Microsoft Clipchamp and Powerpoint.

Results/Outcomes: Given the short rectal stump and likely involvement of the vagina based on pre-operative imaging, we proceeded with a completely posterior approach completion proctectomy with posterior vaginectomy. The perineal and posterior vaginal wall defects were reconstructed with a pedicled gracilis myocutaneous flap, a choice made so that we could complete this case from a totally posterior approach.

Conclusion/Discussion: Surgical care and reconstructive techniques should be personalized to individual patient anatomy and cancer recurrence patterns. Completely posterior proctectomy with myocutaneous flap reconstruction is a feasible approach for the treatment of recurrent rectal cancer with vaginal invasion.