2020 Volume 53 Issue 11 Pages 916-924
We present a case of locally advanced anal fistula cancer that was resected by total pelvic exenteration with genitalia resection and extensive perineal skin tissue resection. The patient was a 56-year-old man with a history of anal fistula treated at another hospital 15 years earlier. He was referred to our hospital for intractable anal fistula exacerbation and presented with many fistulas and drainage from the buttocks to the scrotum and penis. He was diagnosed with anal fistula cancer by biopsies from a fistula in the posterior wall of the anal canal. Preoperative CT and MRI revealed small bowel fistulas and suspected fistulas involving the urethra and bladder, which caused severe inflammation in the perineum. We performed sigmoid colostomy to improve his general condition prior to curative surgery. The patient then underwent total pelvic exenteration with genitalia resection, extensive perineal skin tissue resection, and treatment with a rectus abdominis musculocutaneous flap. He is currently alive without evidence of recurrence 19 months after surgery. For locally advanced anal fistula cancer with massive invasion into surrounding tissues and perineal skin, a wide en bloc resection including external genital resection is the preferred treatment.
