V96 - Transvaginal approach for pelvic recurrence after extensive surgery for clinical T4bN2M0 rectosigmoid junction cancer: An innovative surgical report

CME Eligible

Purpose/Background: Pelvic recurrence following extensive surgery for advanced colorectal cancer necessitates a time-consuming adhesiolysis. Traditional transabdominal reoperation in this setting is associated with prolonged operative time, technical challenges, and increased morbidity, especially in elderly patients or those with significant comorbidities. We report the feasibility of a transvaginal approach for pelvic recurrence in a high-risk patient, as a novel alternative to conventional surgery.

Methods/Interventions: The 68-year-old woman with history of low anterior resection, partial cystectomy and extensive lymphadenectomy around left external and internal iliac artery and vein for advanced rectosigmoid colon cancer (cT4bN2M0) 3 years earlier, which confirmed as pT3N1M0 on pathologic examination, presented with vaginal bleeding. Her medical history included total abdominal hysterectomy with bilateral salpingo-oophorectomy, open cholecystectomy, chronic kidney disease requiring hemodialysis, hypertension, diabetes mellitus, cerebrovascular accident, and prior myocardial infarction. Imaging with abdominopelvic CT and pelvic MRI identified a 4.2 cm soft tissue at the vaginal stump without invasion of adjacent organs, which proven as metastatic adenocarcinoma of colonic origin. A transvaginal approach was selected following multidisciplinary consensus due to high surgical risk.

Results/Outcomes: Colposcopic examination revealed a necrotic lesion with active bleeding. GelPOINT® access port was introduced into the vaginal canal after separated closing of vaginal wall with tumor by gynecologic team. Meticulous dissection was carried out in the planes between the vagina and adjacent organs. En bloc resection of the recurred mass was achieved with negative margins, confirmed by intraoperative frozen section, after dissection from the small bowel, urinary bladder and rectum. Bladder and rectal wall integrity were verified with leak tests. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 6.

Conclusion/Discussion: This is the first report demonstrating that a transvaginal minimally invasive approach may be a feasible alternative for recurrent lesions that are suspected to pose high technical difficulty or an increased risk of morbidity.