Mucinous adenocarcinoma associated with a chronic perianal fistula - a review of cases from a single institution.
OBJECTIVE
The purpose of this study was to evaluate the clinicopathological features of mucinous adenocarcinoma associated with perianal fistulas (MAF), to assess the importance of preoperative MRI analysis, and to determine the optimal surgery.


METHODS
We performed a retrospective analysis of the data from seven patients with MAF treated at our hospital between 2000 and 2013, and herein discuss the importance of preoperative magnetic resonance imaging (MRI) and of radical surgery.


RESULTS
The male to female ratio was 5:2, and the mean age of the patients was 63 years old (28-70). The median duration of chronic fistulation was 16 years (5-40). The tumor extension was classified as II+III+IV in five patients and as II+III in 2 patients according to the Sumikoshi classification, as determned by pelvic MRI. The performed surgeries were 3 abdominoperineal resections with sacral resection and 4 pelvic exenterations with sacral resection. Two local recurrences developed in patients with R1 resection, and 1 distant metastasis occurred in 1 patient with R0 resection.


CONCLUSIONS
For patients with MAF, a curative surgical resection is the only definitive treatment that can be expected to provide a good prognosis. The application of the Sumikoshi classification using MRI may provide a precise assessment of the extension of MAF, which can allow the appropriate surgery to be selected for the patients with MAF.
Dept. of Surgery, Division of Plastic Surgery, Nara Medical University.
Fumikazu
F
Koyama
Tadashi
T
Nakagawa
Shinji
S
Nakamura
Takeshi
T
Ueda
Naoto
N
Nishigori
Takashi
T
Inoue
Keijiro
K
Kawasaki
Shinsaku
S
Obara
Takayuki
T
Nakamoto
Kazuaki
K
Uchimoto
Hisao
H
Fujii
Akira
A
Kido
Yasuhito
Y
Tanaka
Katsunori
K
Yoshida
Kiyohide
K
Fujimoto
Masamitsu
M
Kuwahara
Yoshiyuki
Y
Nakajima
D002288:Adenocarcinoma, Mucinous / Q000209:etiology / Q000601:surgery; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012003:Rectal Fistula / Q000150:complications / Q000473:pathology* / Q000601:surgery; D012004:Rectal Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies