LAPAROSCOPIC SURGICAL TREATMENT AFTER NEOADJUVANT THERAPY FOR LOW RECTAL NEOPLASM IN A LOW-RESOURCE SETTING: CASE REPORT
Surgical practice differs between tertiary centres and low-resource settings, with major differences in personnel training, equipment and financial resources. COVID-19 crisis deepened this rift, highlighting the problems in national health systems. We present the case report of a 76-year-old patient diagnosed with low rectal cancer, treated with laparoscopic abdominoperineal resection with neoadjuvant therapy in our centre. Patient presented for investigations with rectal tenesmus, rectal bleeding and incontinence at 3 months after being treated for a stroke that left him with left side hemiparesis. Rectal examination revealed a semi-circular, vegetative, non-stenosing mass 3-4 cm inside the anal cavity, visible at colonoscopy, while abdominal exam showed nothing pathological. An abdominal-pelvic CT revealed a tumoral mass on the anterior rectal wall, largest diameter being 35 mm, associated with nodules in the mesorecta fatty tissue up to 10 mm. Pre-surgical treatment was done in another centre, consisting of radiotherapy (25Gy) with good clinical tolerance. During laparoscopic abdominoperineal surgery we collected 6 anatomopathological fragments leading to a diagnosis of pT2N0Mx (AJCC stage 2) rectal adenocarcinoma. Patient initiated 8 rounds of CAPOX cytostatic therapy at 2 months post-surgery with no accidents or complications. Patient returned for follow-up at 6 months and there were no signs of recurrence of rectal cancer or any signs of metastases. This case presentation shows what can be done in one low-resource setting when local governments and practitioners get involved in allowing a small regional centre to regain its importance in treating oncologic patients, allowing tertiary centres to focus on complex cases.
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