Simultaneous Vaginoplasty with Acellular Dermal Matrix and Pedicled Omental Flap and Pull-Through Colon-Anal Anastomosis for Low Rectal Cancer with Vaginal Invasion.

Background: In distal locally advanced rectal cancer with vaginal invasion, simultaneous bowel and vaginal reconstruction is technically challenging. Here, we describe a technique of simultaneous vaginoplasty and colon-anal anastomosis.

Methods: A 64-year-old woman was diagnosed with rectal mucinous adenocarcinoma 5 months ago. Colonoscopy showed that the tumor was located on the anterior rectal wall, with its lower edge adjacent to the dentate line. Pelvic MRI revealed that the tumor involved the posterior vaginal wall. The patient expressed a strong desire for sphincter preservation. Following a series of multidisciplinary team discussions for oncological feasibility, neoadjuvant chemotherapy (CapeOx, ycT4bN0M0, partial response) and subsequent radical sphincter-preserving surgery were conducted. The surgery mainly included laparoscopic-assisted intersphincteric dissection and extensive resection of posterior vaginal wall with partial external anal sphincter. Sphincteroplasty was performed to restore anal function, followed by a pull-through colon-anal anastomosis. Vaginoplasty was performed using a human acellular dermal matrix, which worked by promoting fibroblasts to migrate and proliferate, and stimulating the growth of endothelial and epithelial cells. Tissue healing was further supported by pedicled greater omental transplantation.

Results: The operative time was 250 min. The blood loss was 150 ml. Postoperative course was uneventful, and the patient was discharged 8 days after surgery. The pulled-through bowel was resected 3 weeks after surgery. Postoperative pathology confirmed a rectal mucinous adenocarcinoma with vaginal invasion (ypT4bN0M0). All margins were clear.

Conclusion: We describe a feasible technique of simultaneous bowel and vaginal reconstruction for low rectal cancer with vaginal invasion.