The role of surgery in perianal disease developing in hematology malignancy patients

Abstract

Objective: Perianal diseases may impair the comfort of life in immunosuppressive patients as well as cause life-threatening complications. In this study, we aimed to analyze the surgical management and results of perianal region diseases in hematological patients who were consulted by the hematology clinic and to present non-surgical treatment options in these patients. Method: The files of the patients who were consulted by the Hematology Clinic of our hospital between January 2011 and January 2021 due to perianal disease were retrospectively reviewed. Patients with multiple data deficiencies were excluded from the study. Gender, age, hematological diagnosis, neutropenic status, number of consultations, surgical diagnosis, radiological imaging methods, treatment modalities and survival data of the patients were recorded. Results: A total of 911 consultations were requested from 627 patients. The number of patients consulted with the diagnosis of perianal disease was 147. Ninety (61.2%) of the patients were male and 57 (38.7%) were female. Of the patients, 74 (50.3%) had acute myeloid leukemia, 29 (19.7%) lymphoma, 15 (10.2%) acute lymphoblastic leukemia, 12 (8.1%) myelodysplastic syndrome, 10 (6.8%) multiple myeloma, 7 (4.7%) of them were followed up with the diagnosis of chronic lymphocytic leukemia, 53 (36%) patients had additional systemic disease besides hematological disease. All patients were examined and prediagnosed. Magnetic resonance imaging was performed in 72 patients with suspected abscess and fistula. Surgical treatment methods were applied to 30 (20.4%) of the patients. Conclusion: Perianal diseases frequently accompany hematological diseases, especially in neutropenic periods. With early examination, close follow-up and appropriate treatment, surgical necessity and the number of relapsed diseases can be minimized.

Keywords

• Hematology
• Neutropenia
• Perianal Disease
• Leukemia
• Lymphoma

References

1. Perazzoli C, Feitosa MR, Figueiredo-Pontes LL, Rocha JJR, Simões BP, Féres O. Management of acute co-lorectal diseases in febrile neutropenic patients. Journal of Coloproctology 2014; 34:189-192. https://doi.org/10.1016/j.jcol.2014.06.002.
2. Nada EM, Alshoaiby AN, Alaskar AS, Khan AN. Severe anal and abdominal pain due to typhlitis in a leu-kemic patient. J Pain Symptom Manage 2007; 34: 457–9. https://doi.org/10.1016/j.jpainsymman.2007.07.003.
3. Vanhueverzwyn R, Delannoy A, Michaux JL, Dive C. Anal lesions in hematologic diseases. Dis Colon Rec-tum. 1980; 23: 310–2. https://doi.org/10.1007/BF02586835
4. Büyükasik Y, Özcebe ÖI, Sayinalp N, Haznedaroğlu C, Altundağ Ö, Özdemir O et al . Perianal infections in patients with leukemia. Diseases of the colon & rectum 1998; 41: 81-85. https://doi.org/10.1007/BF02236900
5. Schubert MC, Sridhar S, Schade RR,Wexner SD. What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol2009; 15:3201–9. 2 https://doi.org/10.3748/wjg.15.3201
6. Nada EM, Alshoaiby AN, Alaskar AS, Khan AN. Severe anal and abdominal pain due to typhlitis in a leu-kemic patient. J Pain Symptom Manage. 2007; 34: 457–9. https://doi.org/10.1016/j.jpainsymman.2007.07.003
7. Rizzo JA, Naig AL, Johnson EK. Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am. 2010; 90: 45–68 https://doi.org/10.1007/s00384-012-1519-210.1016/j.suc.2009.10.001
8. Palma F. Afecciones anorrectales y hemopatias: aportación detrês casos [Anorectal affections and hemo-pathies: contribution of three cases]. Rev Clin Esp 1963; 2:102–103.

9. Schimpff SC, Wiernik PH, Block JB. Rectal abscesses in cancer patients. Lancet 1972; 2:844–847.
10. Po-Li Wei JJK, Kuo L-J, Lin H-C Increased risk of diabetes following perianal abscess: a population-based follow-up study. Int J Color Dis 2012; 28:235-40. https://doi.org/10.1007/s00384-012-1519-2
11. Morcos B, Amarin R, Abu Sba’ A, Al-Ramahi R, Abu Alrub Z, Salhabet M. Contemporary management of perianal conditions in febrile neutropenic patients. Eur J Surg Oncol 2013; 39:404–407. https://doi.org/10.1016/j.ejso.2013.01.001
12. Bodey GP Unusual presentations of infection in neutropenic patients. Int J Antimicrob Agents. 2000;16: 93–5. https://doi.org/10.1016/s0924-8579 (00)00241-7
13. C. Logan, D. Koura, R. Taplitz, Updates in infection risk and management in acute leukemia Hematology Am Soc Hematol Educ Program 2020 (1): 135–139. https://doi.org/10.1182/hematology.2020000098.
14. Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM. Anorectal disease in neutropenic leukemic pati-ents. Operative vs. nonoperative management. Dis Colon Rectum. 1994;37 (11):1095-1099. https://doi:10.1007/BF02049810
15. Lehrnbecher T, Marshall D, Gao C, Chanock SJ. A Second look at anorectal infections in cancer patients in a large cancer institute: the success of early intervention with antibiotics and surgery. Infection. 2002; 30:272–276. https://doi.org/10.1007/s15010-002-2197-8
16. Chen CY, Cheng A, Huang SY, Sheng W H, Liu JH, Ko BS et al. Clinical and microbiological characteristics of perianal infections in adult patients with acute leukemia. PloS one. 2013;8 (4). https://doi.org/10.1371/journal.pone.0060624
17. Boddie AW Jr, Bines SD (1986) Management of acute rectal problems in leukemic patients. J Surg Oncol 33:53–56. https://doi.org/10.1002/jso.2930330115
18. Steele SR, Kumar R, Feingold DL, Rafferty J L, Buie W D. Standards Practice Task Force of the American Society of Colon and Rectal Surgeons Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 2011; 54:1465–1474. https://doi.org/10.1097/DCR.0b013e31823122b3
19. Rafaela V Loureiro, Verónica P Borges, Ana L Tome, Carlos F Bernardes , Mário J Silva, Maria J Bettenco-urt. Anorectal complications in patients with haematological malignancies. Eur J Gastroenterol Hepatol. 2018 Jul;30 (7):722-726. https://doi.org/10.1097/MEG.0000000000001133
20. Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM. Anorectal disease in neutropenic leukemic pati-ents. Operative vs. nonoperative management. Dis Colon Rectum 1994; 37:1095–1099. https://doi.org/10.1007/BF02049810
21. Shaked AA, Shinar E, Freund H Managing the granulocytopenic patient with acute perianal inflammatory disease. Am J Surg 1986; 152:510–512. https://doi.org/10.1016/0002-9610 (86)90217-5