PMC10368438_01
A, Magnetic resonance imaging (T2 emphasis, sagittal section) before chemotherapy, white arrows indicate massive tumoral invasion to the vagina. B, MRI (T2 emphasis, sagittal section) after chemoradiotherapy. The tumor has been reduced in size but invasion remains (white arrows).
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Computed tomography (CT) and magnetic resonance imaging (MRI) (Figure 1A) scans revealed a mass extending from the rectum to the uterus and vagina. After CRT, the tumor remained but was diminished in size, and thus the therapeutic effect was deemed a partial response (PR) (Figure 1B).
A, Intraoperative pelvic field of view. The fibers have been stripped between the vagina and bladder. B, Illustration of the same field.
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The vaginal submucosa was circumferentially dissected and tightly sutured at 2 cm from the tumor on the distal side (Figure 2).
Images of the abdominal cavity after injection of indocyanine green (ICG) into the vaginal mucosa. Resection of the vaginal area was performed caudal to the ICG-stained area (yellow arrow).
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We shifted to laparoscopic manipulation, and the vagina was dissected at the distal side from the point of rectal cancer invasion, under near-infrared fluorescence image guidance (Figure 3).
Resection pathological specimen, showing that rectal cancer tissue has invaded the vaginal lumen. A, x4 image. B, x400 image.
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Notably, the cut end line of the vagina provided sufficient distance from the site of cancer invasion (Figure 4).