Locally advanced colon cancer. Laparoscopic en-bloc resection.

Abstract

Locally advanced colorectal cancer is a multidisciplinary challenge, representing between 10% and 20% of colorectal cancers. These tumors are classified as T4a when invading the peritoneum or muscular layer and T4b when invading other neighboring structures. En-bloc resective surgery with postoperative adjuvant therapy is the best therapeutic option for curative purposes, with the R0 surgery result being the most important predictor in the patient's outcome. Neoadjuvant therapy is an important factor in improving and reducing local recurrence and increasing survival rates in non-urgent surgery patients.

The case presented is that of a 44-year-old female patient with anemia, abdominal pain, palpable mobile mass in the hypogastrium, and subocclusive symptoms. After diagnostic tests, a locally advanced colorectal tumor was found, and surgical resolution was decided upon. Laparoscopic surgery was performed with a multivisceral resection in block, and an R0 surgery result was achieved. The patient was then put on adjuvant chemotherapy.

In conclusion, locally advanced colorectal tumors should be en-bloc resected with margins to ensure R0 surgery. Multidisciplinary teams capable of resolving organ and/or adjacent vascular structure invasions are necessary. Neoadjuvant therapy reduces local recurrence and improves survival rates.