625 Complex abdominal wall reconstruction in colorectal cancer abdominal wall metastases - a case report

Abstract

Abstract Introduction Resection of abdominal wall metastases with curative intent followed by complex abdominal wall reconstruction is seldom performed due to difficulty in ensuring complete resection and need for abdominal reconstruction. It is difficult to successfully localise the boundaries of these metastases for complete excision whilst balancing excessive tissue loss. We present a patient with anterior abdominal wall metastases from colorectal cancer who had this procedure performed successfully at our hospital. Case Presentation This 46-year-old lady originally underwent emergency Hartmans for a perforated sigmoid tumour invading surrounding tissues; pT4pN0R1. She had postoperative chemotherapy, HIPEC/debulking surgery and immunotherapy. A CT scan then suggested disease progression; however, the only active deposits appeared to be in her bilateral recti, so she underwent curative intent surgery - excision of bilateral rectus abdominis metastases, abdominal wall mesh reconstruction, and abdominoplasty. Histology confirmed completely excised colorectal metastatic adenocarcinoma. She did well postoperatively; currently, she continues immunotherapy and works 70 hours/week! Discussion Localisation and R0 resection of rectus metastases is technically challenging; it involves intensive preparation and working closely with the radiological team. The margins of bilateral rectus metastases were localised via immediate pre-operative CT- guided wire placement by an experienced radiologist interacting continuously with the surgeon in the CT room. Conclusion It is possible to safely excise abdominal wall metastases with intensive preoperative planning with the theatre team and radiologists; resultant abdominal wall defects can be repaired appropriately with resultant good quality of life. This procedure should be considered as an option in the management of abdominal wall colorectal metastases with curative intent in selected patients.