Marc Paul Jose Lopez

En bloc resection of cervical adenocarcinoma with late recurrence to the iliopsoas

This is a case of a 50-year-old woman diagnosed with recurrent cervical adenocarcinoma presenting with chronic and persistent low back pain. She underwent myomectomy for myoma uteri 8 years prior. Histopathology report revealed cervical cancer. She underwent chemotherapy, brachytherapy and external beam radiotherapy. All surveillance work-up, over the years, were negative until she was found to have a solitary recurrent lesion in the right iliopsoas muscle on CT scan. A multidisciplinary team of surgeons collaborated to perform wide excision of pelvic recurrence en bloc right internal hemipelvectomy, right hemicolectomy en bloc resection of external iliac artery and vein, external ilio-iliac artery interposition graft and external iliac vein–common femoral vein bypass. Final histopathologic results showed adenocarcinoma with endometrioid features with associated poorly differentiated high-grade carcinoma involving the iliopsoas, cecum and terminal ileum. Two months postoperatively, the patient is ambulating with minimal assistance.

Total neoadjuvant therapy and abdominoperineal resection with sigmoid colon vaginoplasty for locally advanced rectal adenocarcinoma invading the vagina

This report presents a woman in her 70s with locally advanced rectal adenocarcinoma invading the posterior vaginal wall. She received total neoadjuvant therapy (TNT) consisting of six cycles of capecitabine–oxaliplatin followed by long-course chemoradiotherapy, resulting in significant tumour downstaging. Definitive surgery involved extralevator abdominoperineal excision with near-total vaginectomy and reconstruction using a sigmoid colon flap vaginoplasty. Histopathology confirmed an R0 resection, with two of 17 lymph nodes positive for metastasis. The patient recovered uneventfully, with a viable neovagina, preserved lubrication and no stricture formation. Transient urinary retention resolved with conservative management. This case demonstrates that TNT can facilitate curative resection of complex T4b rectal cancers and enable successful functional reconstruction. The use of a sigmoid colon flap provides a versatile and well-vascularised option for vaginal reconstruction, supporting both oncologic safety and quality of life in extensive pelvic resections.