Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2019; 7(6): 798-804
Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.798
Photodynamic therapy as salvage therapy for residual microscopic cancer after ultra-low anterior resection: A case report
Si-Qi Zhang, Kui-Jie Liu, Hong-Liang Yao, San-Lin Lei, Zhen-Dong Lei, Wen-Jun Yi, Li Xiong, Hua Zhao
Si-Qi Zhang, Kui-Jie Liu, Hong-Liang Yao, San-Lin Lei, Zhen-Dong Lei, Wen-Jun Yi, Li Xiong, Hua Zhao, Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Zhang SQ and Liu KJ drafted the manuscript; Yao HL, Lei SL, Lei ZD, and Yi WJ reviewed and analysed the literature; Xiong L and Zhao H conceived the study and performed the operation, and they contributed equally to this work; all authors approved the final version of the article.
Supported by the National Natural Science Foundation of China, No. 81773293 and No. 81873640; the Natural Science Foundation of Hunan Province, No. 2015JJ4083 and No. 2018JJ3758; the Xiang Cai She Zhi 2017(67) and the Science and Technology Plan Fund in Hunan Province, China, No. 2015GK3117 and No. 2017WK2063.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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 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/
Corresponding author: Hua Zhao, MD, Doctor, Full Professor, Department of Gastrointestinal Surgery, the Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha 410011, Hunan Province, China. lixionghn@csu.edu.cn
Telephone: +86-731-85295822 Fax: +86-731-5533525
Received: December 10, 2018
Peer-review started: December 10, 2018
First decision: January 5, 2019
Revised: February 11, 2019
Accepted: February 18, 2019
Article in press: February 18, 2019
Published online: March 26, 2019
Processing time: 107 Days and 13.1 Hours
Abstract
BACKGROUND

The rate of positive resection margins (R1) in patients with low rectal cancer is substantial. Recommended remedies such as extended resection or chemoradiotherapy have their own serious drawbacks. It has been reported that photodynamic therapy (PDT) as a remedial treatment for esophageal cancer. Colorectal cancer and esophageal cancer has many similarities, however, PDT as a salvage therapy for rectal cancer is rare.

CASE SUMMARY

Here, we describe a 56-year-old man who was admitted to the hospital due to a 6-mo history of hemafecia, which had been aggravated for 1 mo. Colonoscopy revealed a 3 × 4 cm ulcerated mass in the rectum 4 cm from the anus. Preoperative pathological examination showed villous adenoma, moderate-to-high-grade dysplasia, good differentiation, and invasion of the mucosal muscle. The patient had R1 after ultra-low anterior resection, but he refused extended resection and experienced severe liver function impairment after 3 cycles of chemotherapy. Ultimately, the patient underwent PDT to remove R1. After five years of follow-up, there was no liver function impairment, recurrence, metastasis, sexual dysfunction, or abnormal defecation function.

CONCLUSION

This is the first case worldwide in which R1 of rectal cancer were successfully treated by PDT.

Keywords: Low rectal cancer; Photodynamic therapy; Positive microscopic distal margin; Salvage therapy; Removal; Residual microscopic cancer; Case report

Core tip: The rate of R1 in patients with low rectal cancer is substantial, especially when sphincter preservation is desired. Many people refuse to remove the anal sphincter. Thus, further extended resection cannot be performed. In addition, postoperative chemoradiotherapy, which is the second choice to compensate for R1, has disappointing outcomes and numerous drawbacks. Because of many advantages and few side effects of photodynamic therapy (PDT), this approach is increasing in frequency. This case report describes PDT as a salvage therapy for R1 in a patient with low rectal cancer after ultra-low anterior resection; sphincter preservation was achieved, and no recurrence was observed after 5 years.