Search

Early postoperative low compliance to enhanced recovery protocols has been associated with morbidity following colon surgery. The purpose of this study is to evaluate the possible causes of early postoperative low compliance to the enhanced recovery pathway and its relationship with morbidity following rectal surgery for cancer. A total of 439 consecutive patients who underwent elective surgery for rectal cancer have been included in the study. Compliance to enhanced recovery protocol on postoperative day (POD) 2 was evaluated in all patients. Indicators of compliance were naso-gastric tube and urinary catheter removal, recovery of both oral feeding and mobilization, and the stopping of intravenous fluids. Low compliance on POD 2 was defined as non- adherence to two or more items. One-third of patients had low compliance on POD 2. Removal of urinary catheter, intravenous fluids stop, and mobilization were the items with lowest adherence. Advanced age, duration of surgery, open surgery and diverting stoma were predictive factors of low compliance at multivariate analysis. Overall morbidity and major complications were significantly higher (p < 0.001) in patients with low compliance on POD 2. At multivariate analysis, failure to remove urinary catheter on POD 2 (OR = 1.83) was significantly correlated with postoperative complications. Low compliance to enhanced recovery protocol on POD 2 was significantly associated with morbidity. Failure to remove the urinary catheter was the most predictive indicator. Advanced age, long procedure, open surgery and diverting stoma were independent predictive factors of low compliance.

BACKGROUND Distant metastases are found in approximately 35% of patients with gastric cancer at their first clinical observation, and of these, 4%-14% involves the liver. Unfortunately, only 0.4%-2.3% of patients with metastatic gastric cancer are eligible for radical surgery. Although surgical resection for gastric cancer metastases is still debated, there have been changes in recent years, although several clinical issues remain to be defined and that must be taken into account before surgery is proposed. AIM To analyze the clinicopathological factors related to primary gastric tumor and metastases that impact the survival of patients with liver metastatic gastric cancer. METHODS We performed a systematic review of the literature from 2000 to 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The study protocol was based on identifying studies with clearly defined purpose, eligibility criteria, methodological analysis, and patient outcome. RESULTS We selected 47 studies pertaining to the purpose of the review, which involved a total of 2304 patients. Median survival was 7-52.3 mo, median disease-free survival was 4.7-18 mo. The 1-, 2-, 3-, and 5-year overall survival (OS) was 33%-90.1%, 10%-60%, 6%-70.4%, and 0%-40.1%, respectively. Only five papers reported the 10-year OS, which was 5.5%–31.5%. The general recurrence rate was between 55.5% and 96%, and that for hepatic recurrence was between 15% and 94%. CONCLUSION Serous infiltration and lymph node involvement of the primary cancer indicate an unfavorable prognosis, while the presence of single metastasis or ≤ 3 metastases associated with a size of < 5 cm may be considered data that do not contraindicate liver resection.

(1) Introduction: To date, the sensitivity of the Comprehensive Complication Index (CCI) in a homogeneous cohort of colonic resections for oncologic purposes has not been reported. The present study aims to compare the CCI with the conventional Clavien–Dindo classification (CDC) in colon cancer patients. (2) Methods: The clinical data of patients submitted to an elective colectomy for adenocarcinoma were retrieved from a prospectively maintained database. Postoperative complications and length of stay were reviewed, and CDC and CCI scores were calculated for each patient. The association of the CCI and the CDC with the length of stay, prolongation of stay and readmission rate were assessed and compared. (3) Results: The overall postoperative morbidity was 26.9%. In particular, 157 (20.4%) patients had more than one complication. A strong correlation between the two scoring systems was observed (r = 99.4%, 95%CI: 99.3–99.5%). In multivariate analysis, CCI had a higher predictive ability for all endpoints. Regarding subgroup analysis, the difference between the CCI and CDC was progressively increased when evaluating outcome measures in complicated and multi-complicated patients. (4) Conclusion: Both scoring systems adequately report the overall burden of postoperative complications. The CCI showed a greater ability than the CDC to predict hospital stay, particularly in patients with multiple postoperative complications.

Purpose: Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages. Methods: From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method. Results: After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value. Conclusions: SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.

Stapling procedure for prolapsed hemorrhoids (PPh) is a widely accepted surgical procedure for third-degree hemorrhoids. intra-abdominal hemorrhage with retroperitoneal hematoma is an uncommon but possible complication. We report on the non-operative management of a case of intra-abdominal bleeding and retroperitoneal hematoma after PPh in a 56-year-old healthy woman presenting third-degree internal hemorrhoids. On the first postoperative day, the patient developed acute back pain, abdominal pain, abdominal distension with clinical signs of peritoneal irritation at left iliac fossa and hypogastrium and a drop in hemoglobin (hb 7.6 mg/dL). Computed tomography (CT) of the abdomen showed intra-abdominal free blood and an anterior intraparietal hematoma of the rectum. She was treated conservatively with intravenous fluids, antibiotics and analgesia. at the third postoperative day, the hematoma drained through surgical wound spontaneously. The patient was discharged 7 days after the operation with normal bowel movements. At 2 weeks after surgery a CT of control pointed out total resolution of perirectal hematoma. No evidence of clinical problems one month after surgery. The non-operative management of intra-abdominal hemorrhage with retroperitoneal hematoma can be successful in selected patients with hemodynamic stability and no evidence of arterial blushings or pneumoperitoneum at CT.

Summary: Background: Fistula-in-ano is one of the most commonly presenting anorectal diseases. Sphincter sparing treatment options should be considered in patients with complex fistulas. Salvecoll-E gel is a native collagen deantigenated and purified, non-cross-linked equine dermal extract, with an amino acid composition identical to human collagen. Methods: The multicentric trial study was a prospective, single-arm observational clinical study with the objective to assess the efficacy of Salvecoll-E gel for anal fistula repair in 70 patients. All patients had undergone preliminary surgical treatment consisting of positioning of a draining loosing seton that was maintained for a period of 4–6 weeks. After seton removal, a gentle debridement and washing of the fistula track was performed. The scar tissue was removed from the internal orifice. Internal opening was covered by a side-to side mucosal suture. Salvecoll-E was injected through the external opening into the fistula track, the external opening it has been opened. Results: Twelve months after surgery, 55 patients demonstrated a clinically healed fistula (78,5%), 15 patients have a recurrence (21,5%). Most of the recurrences were observed in the first 6 months of treatment (13/15, 86.6%). We don't observe any worsening in CCF score. The results obtained at 1 year certainly seem satisfactory and in line with the best results published in literature using mini-invasive techniques. Conclusion: Salvecoll-E gel is a promising non-invasive technique for conservative treatment of anal fistulas, it's well tolerated by the patients and, in case of recurrence, reinjection or all other known techniques are feasible. Keywords: Complex ano-rectal fistula, Non cutting technique, Mini-invasive treatment

INTRODUZIONE: In accordo con le nuove scoperte fisiopatologiche degli anni ’70 e ’80, la malattia emorroidaria sembra non dipendere dall’iperplasia venosa, ma piuttosto da un progressivo deterioramento dei tessuti connettivi e di supporto con conseguente prolasso venoso e mucoso. Alla fine degli anni ’90 fu introdotta una nuova tecnica chirurgica per un trattamento più fisiologico delle emorroidi: la mucoprolassectomia con stapler. MATERIALI E METODI: Tra ottobre 2017 e giugno 2018 abbiamo eseguito 50 mucoprolassectomie per patologia emorroidaria in anestesia loco-regionale. Tutti i pazienti sono stati classificati come ASA I con un’età compresa tra 18 e 65 anni. Ai pazienti è stato somministrato Atropina 1 mg e Flunitrazepam 0,7 mg per via orale 30 minuti prima dell’intervento. È stata anche applicata una preparazione topica anestetica di Lidocaina e Procaina. Un’anestesia locale della regione anale e perineale è stata eseguita dal chirurgo con assistenza anestesiologica. RISULTATI: Il controllo del dolore intraoperatorio è risultato completo e ottimale nel 92% dei pazienti. Sei pazienti (8%) hanno riportato un lieve dolore durante la fase di resezione. Una conversione in anestesia generale non è mai stata necessaria. Quarantaquattro pazienti (88%) sono stati dimessi lo stesso giorno dell’operazione. In quattro casi (9%) la dimissione è stata posticipata a causa di complicazioni postoperatorie precoci. DISCUSSIONE E CONCLUSIONE: A 20 anni dalla sua introduzione, la mucoprolassectomia con stapler è diventata il gold standard per il trattamento della patologia emorroidaria. Questa procedura permette di preservare la fisiologia del canale anale e di ricostruire la corretta relazione topografica tra derma anale, mucosa ano-rettale, plesso emorroidario e apparato sfinteriale. L’assenza di ferite chirurgiche nella regione perineale consente una ridotta stimolazione dei recettori del dolore, portando ad un decorso post-operatorio meno doloroso e ad un rischio ridotto di complicazioni a lungo termine. L’uso di una stapler comporta costi più elevati ma bilanciati dalla possibilità di un più rapido recupero e una più rapida ripresa delle attività lavorative. La possibilità di eseguire l’operazione in day surgery consente una riduzione globale delle spese sanitarie lasciando più risorse per casi più complessi. INTRODUCTION: Accordingly with the new physiopathologic insights of the 70s and 80s, hemorrhoidal disease appears to originate not much from venous hyperplasia but rather from a progressive deterioration of connective and support tissues with subsequent venous and mucosal prolapse. In the late 90s a new surgical technique for a more physiological treatment of hemorrhoids was introduced: stapled prolassectomy. MATERIALS AND METHODS: Between October 2017 and June 2018 we performed 50 hemorrhoidal stapled prolassectomies under local-regional anesthesia. All patients were classified as ASA I and were aged between 18 and 65 years. Patients were administered Atropine 1 mg and Flunitrazepam 0,7 mg orally 30 minutes prior to the intervention. A topical anesthetic preparation of Lidocaine and Procaine was also applied. A local anesthesia of the anal and perineal region was performed by the surgeon in the presence of an anesthesiologist. RESULTS: Intraoperative pain control was found to be complete and optimal for the majority of patients (92%). Six of the patients (8%) reported mild pain during the stapling phase but did not require further intervention. A conversion to general anesthesia was never required. Forty-four of the patients (88%) were discharged on the same day of the operation. In four cases (9%) discharge was postponed and patients were kept overnight because of early postoperative complications. DISCUSSION AND CONCLUSION: Over 20 years after its introduction, stapled prolassectomy has become the allows to gold standard for treating hemorrhoids. This procedure allows for an effective and appropriate treatment of the condition. It preserve the physiology of the anal channel and to reconstruct the correct topographic relationship between anal derma, anal-rectal mucosa, hemorrhoidal plexus and sphincter apparatus . The absence of surgical wounds in the perineal region allows for a reduced stimulation of pain receptors, leading to a less painful post-operatory course and to a reduced risk of long term complications such as stenotizing scarring and soiling .The use of a mechanic stapler leads to higher costs, but they are in part balanced by the possibility of a faster recovery of patients and of an earlier resumption of work activities. The possibility to perform the operation in day surgery may allow for a global reduction health care expenses leaving more resources available for more complex cases. KEY WORDS: Hemorrhoids, Recto-Anal prolapse, Posterior perineal block.

Background: Perianal giant condyloma acuminatum (gCa) is a rare clinical condition related to low-risk human papillomavirus (hPV) characterized by a circumferential, exophytic, cauliflower-like mass. GCA is not a malignant lesion by histologic criteria but often shows a propensity to compress or infiltrate adjacent tissues and harbor tumor foci with high potential for malignant transformation (30-56%). Local extent of tumor invasion, not malignant histology, had the greatest impact on morbidity. Local full thickness surgical excision with 1 cm macroscopically negative margins is presently considered the most appropriate treatment for this type of lesion. Methods: This study reports successful treatment of 13 patients (11 males, 2 females, mean age 38.5 years old) with a new surgical approach. This technique consists in the removal of a mucocutaneous cylinder containing the entire lesion with 1 cm of disease-free margin both on the perianal skin and on the mucosa of the anal canal. Subsequently, the mucosa of the anal canal is sutured to the external margin of the internal sphincter with detached points in absorbable material. The anesthetic technique was spinal anesthesia. Results: The early postoperative period was uneventful in all 13 patients. Complete healing occurred in 40 days. Two months from surgery, no findings of anal stenosis were reported except for 2 patients (due to an incorrect postoperative management). No findings of mucosal ectropion two months after surgery. at the 1-year follow-up, there was no recurrence of condylomatosis in any patient. Conclusions: This procedure seems to combine technical simplicity, rapid discharge, low complication rates (no anal stenosis nor mucosal ectropion) and without recurrence of condylomatosis after 1-year follow-up. For all these reasons we think it might be a valid therapy for gCa.

INTRODUZIONE: La colpo-cisto entero defecografia rappresenta oggi il gold standard per l’identificazione e la stadiazione dei disordini morfologici e funzionali della regione retto-anale e del pavimento pelvico nelle sindromi da defecazione ostruita. MATERIALI E METODI: Tra Gennaio 2010 e Gennaio 2013 88 pazienti sono stati sottoposti a procedura di STARR per sindrome da defecazione ostruita (ODS) causata da rettocele e intussuscezione retto-anale. Abbiamo analizzato retrospettivamente i dati raccolti ed in particolare rivisto i risultati defecografici pre-operatori. RISULTATI: 30 pazienti (34%) alla colpo-cisto entero defecografia pre-operatoria, avevano un’apertura del canale anale compresa tra 0 e 5 secondi, 44 (50%) tra 6 e 10 secondi e 14 pazienti (16%) superiore ai 10 secondi. Le immagini hanno mostrato presenza di enterocele in 30 pazienti (34%). In 25 pazienti (28,4%) si trattava di enterocele dinamico, in 5 (5,6%) di enterocele stabile. 53 pazienti avevano un rettocele di II° (60,2%) e 35 pazienti un rettocele di III° (39,7%). I’ ODS score medio preoperatorio era 14. Il punteggio medio di ODS rivalutato a 1 anno è stato di 3,1, 4,3 a 3 anni e 6,4 dopo 5 anni. Il miglioramento del punteggio ODS era inferiore nel sottogruppo di pazienti che presentavano un’apertura lenta del canale anale (> 10 sec): 7,5 a un anno, 9,1 a 3 anni e 11 dopo 5 anni di follow-up. Anche nel sottogruppo di pazienti con enterocele stabile (5,6%) il miglioramento era meno evidente: 6,7 a 1 anno, 8 a 3 anni e 9,7 dopo 5 anni di follow-up. DISCUSSIONE E CONCLUSIONE: I dati ottenuti ci hanno dimostrato che la coesistenza di un lungo periodo di apertura del canale anale e / o la presenza di un enterocele stabile sono fattori che riducono significativamente l’efficacia della chirurgia riducendo il miglioramento dell’ODS score nel breve e lungo periodo. Consigliamo pertanto nel primo caso l’associazione di fisoterapia perineale mentre nel secondo una plastica del cavo del Douglas. INTRODUCTION: The conventional video colpo-cysto entero defecography describing the morpho- functional imaging features, physiological and pathological of the recto-anal region and pelvic floor . It represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions. MATERIALS AND METHODS: Between January 2010 to January 2013 88 patients underwent STARR procedure for obstructed defecation syndrome (ODS) caused by single rectocele or internal rectal intussusception. We retrospectively analyzed the collected data,in particular we reviewed the defecography results before surgery. RESULTS: At defecography imaging , 30 patients (34 %) had an anal canal opening between 0 and 5 seconds, 44 (50 %) between 6 and 10 seconds and 14 patients (16 %) over 10 seconds at defecography imaging. The defecography showed an enterocele in 30 patients (34 %) The enterocele was functional in 25 (28,4 %) and stable in 5 (5,6 %) patients. 53 patients have a II° rectocele (60,2 %) and 35 patients a III° rectocele (39,7 %). The average preoperative ODS score was 14 . The average ODS score revaluated at 1 year was 3.1, 4.3 at 3 years an 6,4 after 5 years. The improvement of the ODS score was lower in the subgroup of patients presenting a slow opening of the anal canal (> 10 sec): 7.5 at one year, 9.1 at 3 years and 11 after 5 years follow-up. Also in the subgroup of patients with stable enterocele (5,6 %) the improvement was less evident: 6.7 at 1 year, 8 at 3 years and 9.7 after 5 years follow-up. DISCUSSION AND CONCLUSION: We have observed that a coexistence of a long opening time of the anal canal and / or the presence of a stable enterocele are factors that significantly reduce the effectiveness of the surgery leading over time to ODS score values close to those present before surgery. In the fisrt case we suggest a pre and post-operative perineal physiotherapy, in the second case a Dougla's platsy KEY WORDS: Defecography, Obstructed defecation syndrome, Rectocele, Recto-anal prolapse.

Direct inguinal blunt trauma is an uncommon but possible cause of bowel perforation in patients with groin hernia. in this case report we want to describe bowel perforation in a 67-year-old patient with bilateral groin hernia due to a directly inguinal blunt trauma managed with loop ileostomy with rod. This case reveals the importance of elective hernia repair and the value of clinical and instrumental evaluation of a patient with groin hernia after direct blunt trauma.

Il condiloma acuminato gigante (GCA) è una rara lesione simile a cavolfiore, nota anche come tumore di Buschke-Lewenstein (BLT). Sebbene sia caratterizzato da caratteristiche istologiche benigne, il comportamento locale del GCA può essre estremamente aggressivo, mostrando una progressiva infiltrazione delle strutture circostanti che portano alla distruzione del tessuto mediante compressione. Poiché la correlazione tra lo sviluppo di HPV e GCA è aumentata, la maggior parte degli Autori è giunta alla conclusione che l’HPV non solo può causare condilomatosi, ma, associato a particolari fattori di rischio, può portare a condizioni molto più gravi come BLT. Poiché il trattamento della GCA non è ancora standardizzato, è necessaria un’analisi preoperatoria molto accurata delle lesioni per pianificare l’approccio terapeutico più adatto. Sulla base delle attuali conoscenze, la valutazione macroscopica dell’invasione locale del tumore e l’estesa resezione radicale sembrano essere l’unico approccio terapeutico valido. In attesa di nuove tecniche e nuovi trattamenti di risparmio tissutale, al momento, la GCA dovrebbe essere trattata con un’escissione radicale senza una ricostruzione tissutale immediata; complicazioni a lungo termine, come la stenosi, possono essere prevenute con un’adeguata guarigione delle ferite e con un programma di follow-up particolarmente intenso e a lungo termine. Giant condyloma acuminatum (GCA) is a rare cauliflower-like lesion, also known as Buschke-L ewenstein tumor (BLT). Although characterized by benign histological features, the local behavior of GCA is extremely aggressive, showing progressive infiltration of the surrounding structures leading to tissue destruction by compression. As the correlation between HPV and GCA development grew stronger, the majority of the Authors came to the conclusion that HPV can not only cause CA but, associated with particular risk factors, it can lead to much more serious conditions such as BLT. Since the treatment of GCA is still not yet standardized, a very accurate pre-operative analysis of the lesions is required to plan the most suitable treatment approach. Based on current knowledge, macroscopic evaluation of local tumor invasion and extensive radical resection appear to be the only valid therapeutic approach, due to its association with longterm survival and minimal recurrence. Looking forward for new techniques and new tissue sparing treatments, at the moment, GCA can be safely treated with radical excision without immediate tissue reconstruction; long-term complications, such as stricture and stenosis, can be prevented by adequate wound healing and by a particularly intense and long- term follow-up program. KEY WORDS: Anus, Giant condyloma acuminatum.

INTRODUZIONE: Gli elevati costi di ospedalizzazione hanno incoraggiato una maggiore attenzione verso la riduzione della degenza ospedaliera. Al giorno d’oggi, molte procedure chirurgiche possono essere eseguite in regime di day-surgery. Una degenza ospedaliera breve comporta molti vantaggi per i pazienti: minori disagi, minori rischi di infezione ospedaliera e un veloce ritorno al lavoro. In proctologia, le procedure in regime di day-suregry non sono ancora molto diffuse per paura delle possibili complicazioni. In questo lavoro riassumiamo la nostra esperienza di 15 anni, sottolineando la possibilità di eseguire anche procedure complesse in anestesia locale-regionale e in un contesto di day-surgery. MATERIALI E METODI: I pazienti devono essere classificati come ASA I o II. RISULTATI: Tra il 2005 e il 2015 la nostra unità operativa ha eseguito un totale di 2688 procedure proctologiche in day surgery. 1062 procedure sono state completate in anestesia locale esclusivamente e tutti i pazienti sono stati dimessi tra due e tre ore dopo la procedura senza complicazioni significative. Negli altri 1626 pazienti il blocco posteriore perineale è stato eseguito in 932 casi (57,3%), ha fornito un controllo ottimale del dolore nel 51,6% dei casi (301 pazienti) mentre nel 5,7% dei casi c’è stata la necessità di somministrazione endovenosa di Fentanil. DISCUSSIONE E CONCLUSIONE: La day surgery è oggi una realtà concreta, resa possibile da un’attenta selezione dei pazienti, un’accurata tecnica chirurgica, un attento monitoraggio del paziente nel periodo postoperatorio e un monitoraggio continuo dell’efficacia dei farmaci antidolorifici. Negli ultimi decenni il nostro team chirurgico ha sviluppato tecniche modificate di anestesia loco-regionale che ci consentono di eseguire procedure anche complesse e di dimettere il paziente entro 24 ore. INTRODUCTION: The actual high hospitalization costs have encouraged a growing attention towards reducing hospital stay. Nowadays, many simple surgical procedures are carried out in a one-day surgery regimen . A shorter hospital stay brings many advantages for the patients: lesser inconvenience, a lower risk of hospital infection and an earlier return to work. In proctology, day surgery polices are still uncommon because surgeons fear possible complications. In this paper we sum up our 15 years experience, stressing the possibility to perform even complex procedures in local-regional anesthesia and in a day-surgery context. MATERIALS AND METHODS: In our experience, to be candidate to one-day surgery proctological procdures, patients should be classed as ASA I or II. RESULTS: Between 2005 and 2015 our operative unit executed a total of 2688 proctological procedures in a one-day surgery. 1062 procedures have been completed under local anesthesia exclusively and all patients have been discharged between two and three hours after the procedure without significant complications. In the other 1626 patients perineal posterior block was performed in 932 cases (57.3%) and provided an optimal pain control in 51,6% of cases (301 patients) while in 5,7% of cases there was the need for an intravenous administration of Fentanil. DISCUSSION AND CONCLUSION: Day-surgery is nowadays a concrete reality, made possible by an attentive selection of patients, an accurate surgical technique, an attentive patient monitoring in the postoperative period and a continuous monitoring of the effectiveness of pain medications. Over the last decades our surgical team has developed modified techniques of loco-regional anesthesia that allow us to perform even complex procedures and discharge the patient within 24 hours. KEY WORDS: Day-surgery, Haemorrhoids, Proctological procedures.

La trasformazione maligna di una fistola perineale cronica è un’entità rara in pazienti che non siano affetti da morbo di Crohn. Fino ad oggi, solo un piccolo numero di carcinomi derivanti da una fistola anorettale cronica sono stati descritti in letteratura. Un uomo di 72 anni con ascesso perineale e una storia di fistola perineale nota da circa 6 anni e senza arriva alla nostra attenzione. In precedenza aveva subito tre interventi chirurgici in altre istituzioni per incisione e drenaggio di ascessi perianali ricorrenti. Il paziente è stato sottoposto ad intervento di drenaggio, fistulotomia parziale con apposizione di setone lasso e biopsia del tessuto . L’esame anatomopatologico del campione ha rivelato un adenocarcinoma mucosecernente derivante dal tramite fistoloso. Il paziente è stato sottoposto a ad amputazione addominale perineale. Il follow-up oncologico a due anni è negativo. La diagnosi di adenocarcinoma mucinoso derivante da fistola perianale è rara, soprattutto nei pazienti senza fattori di rischio. Un’ampia resezione del tumore con la procedura di Miles rappresenta ancora il trattamento chirurgico di scelta permettendo di fornire un buon risultato a lungo termine, in termini di recidiva e sopravvivenza, nella malattia localizzata. Up to date, only a small number of carcinomas arising from a chronic anorectal fistula have been described in medical literature, especially in patients without Chron's disease. A 72-year-old man with a 6-year history of discharging perianal sinus without Crohn's disease arrived at our institution. He had previously undergone three surgical procedures in other institutions for incision and drainage of recurrent perianal abscesses. Our therapeutical approach was to drain the two abscess cavities, perform a fistulectomy, and biopsy the fistula tissue. Anatomopathological examination of the specimen revealed a mucosecerrnig adenocarcinoma arising from the fistula tract. We decided to perform an abdominal perineal resection. The two-year oncological follow-up is negative. In conclusion, it is clear that the diagnosis of mucinous adenocarcinoma occurring in perianal fistula is difficult, particularly in patients without any risks or predisposing factors. Wide resection of the tumor with Miles's procedure still represents the surgical treatment of choice and may provide a good long term outcome in localized disease KEY WORDS: Cronic anorectal fistula, Malignant transformation, Mucinous adenocarcinoma.