Abstract
BackgroundThe strategy for treating obstructive colon cancers with metastatic lesions remains unclear. Herein, we report a case of laparoscopic ileo-transverse colon bypass (LITB) before preoperative chemotherapy for an obstructive right colon cancer.Case presentationA 59-year-old woman was referred to our institution (Department of Gastroenterological Surgery, Chiba Cancer Center) for liver tumors detected on ultrasound. The clinical diagnosis was ascending colon cancer with multiple liver metastases. Based on the criteria of the International Union against Cancer Committee, 8th edition, the staging was confirmed as cT4aN1M1a(H), cStage IV. Although the primary tumor in the ascending colon extended beyond the colonic wall, curative resection was possible for both primary and metastatic tumors. We planned to administer chemotherapy before the radical surgery to obtain tumor-free resection margins; however, as the obstruction was fatal, LITB was prioritized and performed using five ports. An intracorporeal side-to-side anastomosis was performed between the ileum, 25 cm from the terminal ileum, and the transverse colon. The patient was discharged on postoperative day 18 without any complications. After LITB, for preoperative chemotherapy, five courses of capecitabine plus oxaliplatin (CapeOX) + bevacizumab were administered. Six weeks after the preoperative chemotherapy, right hemicolectomy with D3 lymph node dissection and right hepatectomy were performed. Pathological findings of the resected specimen confirmed curative resection of both lesions, and a favorable effect of chemotherapy was obtained. The patient has been alive for over 8 months after the surgery, with no evidence of cancer recurrence.ConclusionsThis case report demonstrates the effectiveness of LITB for obstructive right colon cancer in patients who need preoperative chemotherapy.
Highlights
The strategy for treating obstructive colon cancers with metastatic lesions remains unclear
This case report demonstrates the effectiveness of laparoscopic ileo-transverse colon bypass (LITB) for obstructive right colon cancer in patients who need preoperative chemotherapy
The patient required curative resection, but as the primary tumor in the colon extended beyond the colonic wall, we decided to administer preoperative chemotherapy before the radical surgery to obtain free radial resection margins
Summary
There are many treatment strategies for obstructive advanced colon cancers. After the bypass was established, preoperative chemotherapy was administered, and radical resection of the primary lesion and metastatic area was performed. We have included LITB as a curative treatment strategy and administered molecular-target drugs to obtain tumor shrinkage of the primary and metastatic lesions. By combining these therapies, we could achieve curative resection for advanced colon cancer. The patient required curative resection, but as the primary tumor in the colon extended beyond the colonic wall, we decided to administer preoperative chemotherapy before the radical surgery to obtain free radial resection margins. Six weeks after the preoperative chemotherapy, right hemicolectomy with D3 lymph node dissection and right hepatectomy were performed, based on the diagnosis of ascending colon cancer with multiple liver metastases (ycT4aN1M1, ycStage IV). She has been alive for 8 months after the surgery, with no evidence of cancer recurrence
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