Kinoshita M, Maruyama T, Hike S, Hirosuna T, Kainuma S, Kinoshita K, Nakano A, Ohira G, Uesato M, Matsubara H. Complete resection of recurrent anal canal cancer using endoscopic submucosal dissection and transanal resection: A case report. World J Gastrointest Endosc 2025; 17(1): 101119 [DOI: 10.4253/wjge.v17.i1.101119]
Corresponding Author of This Article
Tetsuro Maruyama, MD, PhD, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Cyuo-ku, Chiba 260-8670, Japan. t.maruyama@chiba-u.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mayuko Kinoshita, Tetsuro Maruyama, Shutaro Hike, Takuya Hirosuna, Akira Nakano, Gaku Ohira, Masaya Uesato, Hisahiro Matsubara, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Shunsuke Kainuma, Department of Surgery, Seirei Sakura Citizen Hospital, Sakura 285-8765, Japan
Kazuya Kinoshita, Department of Surgery, Kumagaya General Hospital, Kumagaya 360-8567, Japan
Author contributions: Kinoshita M wrote this manuscript; Hike S, Hirosuna T, Kainuma S, and Kinoshita K reviewed related literature; Maruyama T, Nakano A, Ohira G, and Uesato M reviewed the manuscript; Matsubara H comprehensively supervised the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tetsuro Maruyama, MD, PhD, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Cyuo-ku, Chiba 260-8670, Japan. t.maruyama@chiba-u.jp
Received: September 5, 2024 Revised: November 22, 2024 Accepted: December 23, 2024 Published online: January 16, 2025 Processing time: 133 Days and 19.4 Hours
Abstract
BACKGROUND
Early anal canal cancer is frequently treated with endoscopic submucosal dissection (ESD) to preserve anal function. However, if the lesion is in the anal canal, then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.
CASE SUMMARY
A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line. The patient underwent a combination of ESD and transanal resection (TAR). The specimen was excised in pieces, which resulted in difficulty performing the pathological evaluation of the margins, especially on the anal side where TAR was performed and severe crushing was observed. Careful follow-up was performed, and local recurrence was observed 3 years postoperatively. Because the patient had superficial cancer without lymph node metastasis, local resection was performed again. The second treatment attempt was improved as follows: (1) TAR and ESD were performed appropriately based on the situation by the same physician; (2) A needle scalpel was used during TAR to prevent tissue crushing; and (3) The lesion borders were marked using ESD techniques before treatment. Complete resection was performed without complications.
CONCLUSION
Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
Core Tip: Early anal canal cancer is frequently treated with endoscopic submucosal dissection at many institutions to preserve the anal function. However, lesions located in the anal canal are more difficult to resect because of the high risk of bleeding and difficulty of endoscopic manipulation. We encountered a case of early anal canal cancer that recurred after insufficient combined endoscopic submucosal dissection and transanal resection. After improving the treatment technique, complete resection of the lesion was achieved. This report describes the precautions and areas of improvement related to our treatment method.
