title: Perineal approach for a gastrointestinal stromal tumor on the anterior wall of the lower rectum.
abstract: BACKGROUND
  Wide margins of resection and regional lymphadenectomy for GIST are not necessary. Several procedures for rectal GIST have been designed according to the location and size of the tumor to preserve the anal function and decrease the morbidity rate.
  
  
  METHODS
  We report a 61-year-old-man with rectal bleeding. Proctologic examination revealed a small mass of approximately 2 cm in diameter on the anterior wall of the rectum at a distance of 4 cm from the anal verge. Histological examination of the biopsy sample via the rectum led to a diagnosis of GIST due to immunohistochemical positivity for C117 and CD34. Perineal resection was planned because abdominoperineal resection with sacrificing the sphincter function was excessive for this small tumor, and low anterior resection with the double stapling technique was difficult due to the lower position. A hemispheric incision was made from one mid-ischial tuberosity to the other with an apex of approximately 2 cm above the anus. The fascia band and muscles were successively transected in order to expose the anterior wall of the rectum, and excision of the tumor was performed. The postoperative course was uneventful, and the patient remained free from incontinence and recurrence.
  
  
  CONCLUSIONS
  This perineal approach for a GIST on the anterior wall of the rectum is one option for preserving the anal function and decreasing the morbidity rate.
authors.affiliation: Department of Surgery, Naga Municipal Hospital, 1282, Uchita, Kinokawa, Wakayama 649-6414, Japan. hkino@nagahp.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Umano
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Iwamoto
authors.forename: Kazunari
authors.initials: K
authors.lastname: Mori
mesh_terms: D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*