Local Recurrence after Abdominoperineal Resection with Vertical Rectus Abdominis Musculocutaneous Flap:A Case Report of Pelvic Exenteration with Preservation of the Flap

Abstract

A 75-year-old man underwent abdominoperineal resection （ APR ） and reconstruction using a right vertical rectus abdominis musculocutaneous （ VRAM ） flap for fistula-associated anal cancer 1 year ago. Pathological findings revealed mu-cinous adenocarcinoma （ T4N0M0 ） with R1 resection. Six months after surgery, local recurrence developed and he was re-ferred to our hospital. CT findings showed that the recurrent tumor, 30 mm in diameter, was adjacent to the right side of the prostate and the ventral side of the VRAM flap, however, there was no finding of invasion of the feeding vessels. Total pelvic exenteration （ TPE ） with preservation of the VRAM flap was successfully performed. He was discharged on the 27th day after surgery and remains alive without recurrence 1 year after surgery. The VRAM flap has been widely used in perineal reconstruction after extended pelvic surgery. In the case of local recurrence thereafter, redo surgery may be complicated, especially when the flap should be preserved. In this case, fortunate-ly we could achieve R0 resection, however, preservation sometimes threatens curability, therefore, the indication should be carefully considered.