同步机器人括约肌保留直肠切除术结合前列腺切除术用于直肠胃肠道间质瘤及前列腺癌的研究
Simultaneous Robotic Sphincter-Preserving Rectal Resection and Prostatectomy for Rectal Gastrointestinal Stromal Tumor and Prostatic Cancer
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影响因子:3.5
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2024 Nov
作者:
Anqi Wang, Anbang Wang, Xinyun Xu, Ming Chen, Haiyang Zhou
DOI:
10.1245/s10434-024-16028-8
摘要
同步直肠与前列腺恶性肿瘤罕见，尚未建立标准治疗指南。1-3 联合机器人直肠与前列腺手术是一种潜在的优良方案，能够管理同步性直肠与前列腺恶性肿瘤，具有微创手术的优势。4 方法：一名78岁男性，既往患有高血压和2型糖尿病，表现为3个月的排便困难和排尿异常。诊断性结肠镜检查显示，距肛门缘3厘米的直肠前壁出现黏膜下肿块，同时血清癌胚抗原（CEA）和前列腺特异性抗原（PSA）水平异常。盆腔CT显示直肠肿块与前列腺边界不清，提示可能侵犯。CT引导活检确认为直肠胃肠道间质瘤（GIST）和前列腺腺泡癌。经过3个月的伊马替尼和巴克替酮新辅助治疗，肿瘤明显缩小。5 随后，患者接受同步机器人括约肌保留直肠切除术和前列腺切除术，先行前列腺切除，随后切除直肠肿瘤，最后采用跑针缝合法进行肠道重建和膀胱输尿管吻合。手术时间为220分钟，估计失血量50毫升。未发生手术并发症，所有切缘均无肿瘤，提示完全切除。患者恢复良好，于术后第7天出院。3个月随访未见复发或功能障碍。同步机器人直肠局部切除术结合前列腺切除术在新辅助治疗后可安全且可行地用于管理同步性直肠GIST与前列腺癌病例。
Abstract
Synchronous rectal and prostate malignancies are rare and standard treatment guidelines have not yet been established.1-3 Combined robotic rectal and prostate surgery represents a potentially excellent approach for managing synchronous rectal and prostate malignancies, offering the advantages of a minimally invasive procedure.4 METHODS: A 78-year-old male with a history of hypertension and type 2 diabetes presented with 3 months of dyschezia and dysuria. Diagnostic colonoscopy revealed a submucosal mass 3 cm from the anal verge in the anterior wall of the rectum, with abnormal carcinoembryonic antigen and prostate-specific antigen levels. Pelvic computed tomography (CT) indicated indistinct boundaries between the rectal mass and the prostate, suggesting potential invasion. CT-guided biopsies confirmed a rectal gastrointestinal stromal tumor (GIST) and prostatic acinar adenocarcinoma. After 3 months of neoadjuvant therapy with imatinib mesylate and bicalutamide, significant tumor reduction was achieved.5 Subsequently, the patient underwent simultaneous robotic sphincter-preserving rectal resection and prostatectomy, starting with the prostatectomy, followed by rectal tumor excision and ending with bowel reconstruction and vesicourethral anastomosis using a running suture technique.The operation time was 220 min and the estimated blood loss was 50 mL. No surgical complications were encountered and all resected margins were free of tumor, indicating a complete excision. The patient recovered well and was discharged on the seventh postoperative day. Follow-up at 3 months showed no evidence of recurrence or functional impairments.Simultaneous robotic sphincter-preserving local rectal resection and prostatectomy can be feasibly and safely performed following neoadjuvant therapy in cases of synchronous rectal GIST and prostate cancer.