REV ARGENT COLOPROCT | 2024 | VOL. 35, N
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2 VIDEO
LAPAROSCOPIC RESECTION OF LOCALLY ADVANCED COLON CANCER Valli DJ, et al.
Locally advanced colon cancer. Laparoscopic resection
Diego J. Valli, Brian Gelblung, Carina Chwat, Flavia Alexandre, Mauro Ramírez, Duarte, Guido Díaz Duarte, Guillermo Rosato, Gustavo Lemme
Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
Keywords: colorectal cancer, T4b, multivisceral resection, locally
advanced
INTRODUCTION
Locally advanced colon cancer is a multidisciplinary chal-
lenge. This type of tumor constitutes between 10 and 20% of
colon cancers. They are classified as T4a when they invade
the peritoneum and T4b when they invade other neighboring
structures.
1
En bloc resection surgery, with postoperative
adjuvant therapy, is the best therapeutic option for curative
purposes.
2
The most important predictor of the outcome of
these patients is R0 surgery.
3
DESCRIPTION
A 44-year-old female patient came to the clinic for anemia,
abdominal pain, a palpable, mobile mass in the hypogas-
trium, and subocclusive symptoms. The laboratory showed
Hb: 7g/dl, hematocrit 23.4%, CEA: 100 ng/ml and Ca 19-9:
1923 U/ml. Colonoscopy revealed a lesion 18 cm from the
anal verge, endophytic, ulcerated, friable, which prevented
the progression of the endoscope. Virtual colonoscopy
revealed circumferential parietal thickening of the sigmoid
colon with involvement of a loop of the small intestine.
Computed tomography (CT) of the abdomen showed thi-
ckening of the distal third of the sigmoid colon, with regio-
nal lymphadenopathy and involvement of the left ovary and
fallopian tube. Chest CT without evidence of secondary
disease. Hospitalization was decided for preoperative clini-
cal optimization. The case was presented in a multidiscipli-
nary meeting and a surgical resolution was decided. A
laparoscopic approach was performed. It began with descent
of the splenic flexure, followed by a medial approach to the
pelvis and the origin of the sigmoid artery.
Section of the terminal ileum and mobilization of the right
colon. Section of the transverse colon and upper rectum with
a 60 mm linear stapler. Given the involvement of the left
adnexa, these were resected en bloc with the tumor. The
surgical specimen included the distal ileum, cecum, ascen-
ding colon, sigmoid colon, fallopian tube, and left ovary.
Reconstruction of intestinal continuity was performed with
intracorporeal isoperistaltic side-to-side ileocolic anastomo-
sis and colorectal anastomosis with a circular stapler. Histo-
pathological report: pT4b pN2b colon adenocarcinoma with
negative resection margins. Immunohistochemistry confir-
med a pMMR tumor, unmutated BRAF, RAS G12 Exon 2.
Currently the patient is receiving 1st-line adjuvant treatment
with FOLFOX + Bevacizumab.
CONCLUSION
Locally advanced colorectal tumors should be excised en
bloc, with adequate margins to guarantee R0 surgery. Multi-
disciplinary teams trained in the resolution of invasion of
adjacent organs and/or vascular structures must be available
to obtain the best results.
REFERENCES
1. Gebhardt C, Meyer W, Ruckriegel S, Meier U. Multivisceral resection of
advanced colorectal carcinoma. Langenbecks Arch Surg. 1999;384(2):194-99.
2. Rosander E, Nordenvall C, Sjövall A, Hjern F, Holm T. Management and
outcome after multivisceral resections in patients with locally advanced primary
colon cancer. Dis Colon Rectum.2018;61(4):454-60.
3. Courtney D, McDermott F, Heeney A, Winter DC. Clinical review: surgical
management of locally advanced and recurrent colorectal cancer. Langenbecks
Arch Surg. 2014;399(1):33-40.
VIDEO: https://youtu.be/SEJuc7YUp2c
The authors declare no conflict of interest. Diego J. Valli: diegojvalli@hotmail.com
Received: August 5, 2023. Accepted: March 5, 2024
Diego J. Valli: ORCID: 0000-0001-5207-2610, Brian Gelblung: ORCID:0000-0002-5947-8266, Carina Chwat: ORCID:0000-0002-2123-0388, Flavia Alexandre: ORCID:0000-0002-3236-4381,
Mauro Ramírez Duarte: ORCID:0009-0009-8983-0118, Guido Díaz Duarte: ORCID:0000-0001-9220-4091, Guillermo Rosato: ORCID:0000-0002-9920-9335, Gustavo Lemme: ORCID:0000-0001-5633-2707