Author(s): Mario Angelo A. Zamora, MD, FPSCRS, Mikhail G. Amante, MD, Marc Paul J. Lopez, MD, FPCS, FPSCRS, and Gerardo G. Germar, MD, FPCS, FPAPRAS

Introduction:
Locally advanced low rectal cancers pose a challenge for surgeons as reported local recurrence remain high despite the performance of Total Mesorectal Excision and the provision of neoadjuvant treatment. Extralevator Abdominoperineal Excision offers better oncologic margins with reported decreased recurrence rates when compared to the conventional technique. The improvement in oncologic outcomes, however, comes at the cost of producing larger perineal defects—and with this comes concerns related to coverage. Presented here is a case of a patient with a locally advanced low rectal cancer with gluteal extension where a Vertical Rectus Abdominis Myocutaneous flap was utilized as a means of perineal reconstruction.

Conclusion:
Extralevator abdominoperineal excision has been shown to have oncologic advantages over the traditional abdominoperineal resection. Although ELAPE produces a wider perineal wound defect, performing a vertical rectus abdominis myocutaneous flap is a viable surgical option for perineal wound coverage. This case report demonstrates that performing ELAPE in combination with VRAM flap perineal reconstruction produces oncologic and cosmetically acceptable outcomes for locally advanced rectal cancers.

Key words: rectal cancer, extralevator abdominoperineal excision, vertical rectus abdominis myocutaneous flap, perineal reconstruction

DOI: