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Session: ePoster: Rectal Cancer 3 (Sun1230)

EP470 - Management of Fournier’s gangrene in patients with rectal cancer at a tertiary referral hospital

Sunday, May 11, 2025
1:08 PM – 1:13 PM PT
Location: Monitor 10, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Paulo T. Carpio (he/him/his)

    Fellow in Training
    Philippine General Hospital, University of the Philippines Manila
    Dasmariñas, Cavite, Philippines

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

    • Author(s)

  • ML

    Marc Paul J. Lopez, MD, FPSCRS, FPCS

    President
    Philippine Association of Colon and Rectal Surgeons
    Manila, National Capital Region, Philippines

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

  • MO

    Mark Augustine S. Onglao, MD, FPSCRS

    Consultant
    Philippine General Hospital, University of the Philippines Manila
    Makati, National Capital Region, Philippines

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

  • Michael Geoffrey L. Lim, MD, PSCRS (he/him/his)

    PSCRS
    Philippine General Hospital, University of the Philippines Manila
    University of Santo Tomas
    manila, National Capital Region, Philippines

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Paulo T. Carpio: This individual has no financial relationships with ineligible companies.
Marc Paul J. Lopez, MD, FPSCRS, FPCS: This individual has no financial relationships with ineligible companies.
Mark Augustine S. Onglao, MD, FPSCRS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Fournier’s gangrene is a rapidly-progressing soft tissue infection with established treatment strategies. However, its management may be complicated when associated with rectal cancer. Due to limited reported cases, there are currently no standard treatment protocols for patients with rectal cancer who develop Fournier’s gangrene. We aimed to describe the management and cancer-related outcomes of such patients seen at a tertiary referral center in a lower middle-income country (LMIC).

Methods/Interventions: This is a descriptive, retrospective review of rectal cancer patients complicated by Fournier’s gangrene from January 2010 to September 2024. Data, including demographics and clinical outcomes, were collected from patient medical records. The key outcomes evaluated were hospital length of stay (LOS), morbidity and mortality rates, and the time intervals the patients navigated between the different phases of Fournier’s gangrene and rectal cancer management.

Results/Outcomes: Data from 24 patients were obtained and analyzed. The patients had a mean age of 53 years (range 24-72 years), majority were male (91.7%, 22/24). Most had locally-advanced, low rectal malignancies. Fifteen patients had a prior diagnosis of rectal cancer, with 4 already having completed neoadjuvant therapy. Nine patients presented with Fournier’s gangrene with undiagnosed cancer.
Radical debridement was performed in all patients, with 62.5% (15/24) required a bowel diversion. Additionally, 46% (11/24) received coverage with a split-thickness skin graft (STSG) during the same admission, leading to a mean LOS of 31 days (range 24-64 days). The overall recovery rate (defined as resolution of all infectious processes; with graft take for those with an STSG, or good granulation for those healing by secondary intention) was 83.33%. Complications included: 1graft loss and 1 hospital-acquired pneumonia. Four patients succumbed to septic shock.
After recovery from Fournier’s gangrene, 4 patients received neoadjuvant therapy, within a range of 4 to 8 months. Only four patients underwent definitive surgery at a mean of 8 months (range 2-16 months) from the time they had Fournier’s gangrene. Twelve patients (50%) did not receive further rectal cancer management as they were lost to follow-up, while others expired.

Conclusion/Discussion: This study highlights the added challenge of managing rectal cancer alongside Fournier’s gangrene, which has a high mortality rate. However, effective management can lead to improved outcomes. It also revealed that this complication can significantly delay the start and completion of the necessary rectal cancer treatment.
Key considerations include the need for bowel diversion, options for reconstruction and coverage, and the importance of timely follow-up for neoadjuvant therapy and definitive surgery. These factors are critical as they directly impact cancer treatment outcomes.