Successful Restoration of Fecal Continence Using Sacral Nerve Stimulation Following Chemoradiation and Transanal Excision of an Anal Melanoma With Partial Internal Anal Sphincter Resection: A Case Report.
OBJECTIVE
This case report provides evidence for our hypothesis that use of a sacral nerve stimulator may be considered in patients with fecal incontinence (FI) following chemoradiation and transanal operations in the setting of cancer including partial internal sphincter resections.


METHODS
A 57-year-old female with a history of anal melanoma was treated with neoadjuvant chemoradiation followed by wide local, transanal tumor excision with partial internal anal sphincter resection that resulted in ≥2 full fecal incontinent episodes/week with gas, liquid, and solid stool leakage ≥10/day requiring pad changes. After seven years of progressive FI, a sacral nerve stimulator was implanted following pre-placement anorectal manometry. Pre and post implant validated Cleveland Cleveland Clinic/Wexner Fecal Incontinence questionnaires and daily stool diaries (Medtronic) were completed. Data was stored in and collected from the patient's electronic health record.


RESULTS
The patient had a single episode of FI during the two week trial phase, but reports complete resolution of FI, urgency, and leakage since implantation through her 1-year post-implant follow-up visit. Additional improvements were noted in FI questionnaires: Cleveland Clinic/Wexner Fecal Incontinence Score of 17 at baseline to 3 post-implant and Fecal Incontinence Quality of Life Score of 3.585 at baseline to 3.93 post-implant.


CONCLUSIONS
The application of sacral nerve stimulation may not be as limited as previously thought and should be considered for cancer survivors following chemoradiation and sphincter-sparing rectal and transanal resections. Though this single case report is suggestive, further research is necessary and would include a research protocol designed specifically for patients who have undergone chemoradiation and/or sphincter-sparing operations. We are currently working on such protocol at our institution.
Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Tyler Cameron
TC
Tolopka
Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Craig A
http://orcid.org/0000-0003-0714-5037
CA
Messick
D001003:Anal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D059248:Chemoradiotherapy / Q000379:methods; D004599:Electric Stimulation Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000000981:diagnostic imaging; D008545:Melanoma / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D012447:Sacrum / Q000000981:diagnostic imaging / Q000294:innervation; D016896:Treatment Outcome
Fecal incontinence; internal anal sphincterectomy; sacral nerve stimulation