Published online Dec 24, 2020. doi: 10.5306/wjco.v11.i12.1070
Peer-review started: July 16, 2020
First decision: August 7, 2020
Revised: August 20, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: December 24, 2020
Abdominoperineal excision (APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss. The objective of the present study was to demonstrate the use of preoperative embolization (PE) as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding, scheduled for APE.
A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus. The patient was diagnosed with bulky adenocarcinoma limited to the rectum. As the patient refused any clinical treatment, surgery without previous neoadjuvant chemoradiation was indicated. The patient underwent a tumor embolization procedure, two days before surgery performed via the right common femoral artery. The tumor was successfully devascularized and no major bleeding was noted during APE. Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.
Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses. We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.
Core Tip: Abdominoperineal excision (APE) remains a major surgery with considerable morbidity. Half of patients undergoing APE have some type of postoperative complication, and bleeding requiring transfusion of blood products is the main morbidity of the procedure. Preoperative embolization as a strategy for blood preservation in a giant rectal hemangioma has been successfully described.