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KMID : 0356720020180020110
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Journal of the Korean Society of Coloproctology
2002 Volume.18 No. 2 p.110 ~ p.114
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Anorectal Cancer Undetected at the Time of Hemorrhoidectomy
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Kang Sung-Bum
Heo Seung-Chul
Jeong Seung-Yong
Choi Hyo-Seong
Park Kyu-Joo
Park Jae-Gahb
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Abstract
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Purpose: Concomitant rectal cancer in a patient with hemorrhoids may be not recognized at the time of hemorrhoidectomy. This study aimed to increase awareness of this entity.
Methods:We reviewed 12 anorectal cancers that were diagnosed within or one year after hemorrhoidectomy, which had been performed in other hospitals. They were followed for a median time of 22.7 months (range, 2 to 80 months) after surgical treatment of anorectal cancers.
Results:Symptoms at diagnosis of cancer were rectal bleeding (67%), defecation difficulty (17%), diarrhea (8%) and anal mass (8%). Eleven tumors (92%) were within the topographic location reachable by digital examination, with median distance of 6 ㎝ from anal verge to the inferior margin of tumor (range, 1 to 10 ㎝). The median size of tumor was 4.5 ㎝ (range, 2 to 7 ㎝). According to histologic type, there were Ⅱ adenocarcinomas and Ⅰ malignant melanoma. The malignant melanoma was located at the incisional scar of hemorrhoidectomy and was found at an advanced stage with lymph node metastasis to the aortic bifurcation area. Surgical treatments were sphincter-saving resection in 10 cases and abdominoperineal resection in 2 cases. On follow-up examination, one case was recurred at the previous incisional scar of hemorrhoidectomy 12 months after low anterior resection due to rectal cancer.
Conclusions:Most of anorectal cancers missed at the time of hemorrhoidectomy were within the topographic
location reachable by digital rectal examination. We found that the hemorrhoidectomy under the missed diagnosis of anorectal cancer amy induce intraluminal seeding of the anorectal cancer may induce intraluminal seeding of the cancer at the incisional scar of hemorrhoidectomy. To prevent this complication, we suggests that the anorectum of hemorrhoidal patients should be examined carefully preoperatively and under anesthesia.
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KEYWORD
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Hemorrhoid, Anorectal cancer
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