REV ARGENT COLOPROCT | 2024 | VOL. 35, N

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.

En bloc resection surgery, with postoperative

adjuvant therapy, is the best therapeutic option for curative

purposes.

The most important predictor of the outcome of

these patients is R0 surgery.

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