Surgical Management of Perianal Giant Condyloma Acuminatum (Buschke-Lwenstein Tumor)

Giant condyloma acuminatum (GCA) is a slow-growing, large, cauliflower-like tumor located in the anogenital region. This tumor has a locally destructive behavior, a high recurrence rate and occasional transformation to squamous cell carcinoma. Risk factors include anoreceptive intercourse, HIV and immunosuppression. There is no general agreement on the choice of treatment for this tumor. Wide radical excision with plastic reconstruction of skin defects seems to be the best treatment, while adjuvant therapies, such as radiotherapy and immunotherapy, may achieve good results, but their effectiveness is still uncertain. Loop colostomy, considered mandatory by several authors in order to minimize wound contamination risk, does not appear to be necessary (except in cases of anal canal involvement beyond the dentate line) if a combination of bowel cleansing, non-fiber diet and loperamide can be administered. The authors report 3 cases of perianal GCA treated by radical local excision and reconstruction by S-plasty grafts, without performing loop colostomy. Copyright © 2006 S. Karger AG, Basel Received: January 24, 2006 Accepted after revision: May 11, 2006 Published online: August 11, 2006 Dr. Giuseppe Cavallaro Department of Surgery ‘P. Valdoni’, Policlinico Umberto I Viale del Policlinico, IT–00161 Rome (Italy) Tel./Fax + 39 06 4997 2197 E-Mail [email protected] © 2006 S. Karger AG, Basel 0014–312X/06/0384–0418$23.50/0 Accessible online at: www.karger.com/esr D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /7 /2 01 7 5: 19 :2 6 A M Treatment of Perianal Buschke-Löwenstein Tumor Eur Surg Res 2006;38:418–422 419 excision, and eventual abdominoperineal resection in cases of recurrence, pelvic invasion or malignant transformation [4, 5, 7] . Many authors recommend performing temporary loop colostomy before surgical excision, to avoid the risk of fecal contamination of the wounds, but this argument is still being debated; in fact, GCA rarely involves the anal canal, and adequate diet and eventual loperamide administration can achieve good results with less discomfort. The authors report 3 cases of perianal GCA treated by radical local excision and reconstruction by S-plasty grafts, without performing loop colostomy.