[A Case Involving Successful Resection of Advanced Lower Rectal Cancer with Perineum Reconstruction after Preoperative Chemotherapy and Chemoradiotherapy].

A 58-year-old woman visited our hospital for diagnosis and treatment of rectal tumor. The tumor was diagnosed as adenocarcinoma metastasizing to the uterus and vagina. Using CT, metastases were detected in the lung, liver, and right inguinal lymph node. First, we performed sigmoid-loop-colostomy. Thereafter, the patient received chemotherapy(CapeOX plus Bev) for 8 courses and chemoradiotherapy(total 50 Gy plus S-1 therapy). Ten months after the initial examination, we performed abdominoperineal resection of the rectum combined with the resection of the posterior wall of the vagina, hysterectomy, and bilateral adnexectomy. Because of a large defect in the perineal region, we also performed reconstruction using the left gracilis muscle flap. The postoperative course was uneventful, and the patient was discharged 22 days after surgery. Once the wound healed, chemotherapy(CapeIRI plus Bev)was initiated. After 10 courses of chemotherapy, metastasis and local recurrence could no longer be detected. This suggests that preoperative chemotherapy, chemoradiotherapy, and perineum reconstruction could enable the radical resection of advanced rectal cancer.