MULTIVISCERAL RESECTION IN COLON CANCER: CASE REPORT

Case Report: A 55-year-old male patient complaining of epigastric pain and weight loss. On physical examination, the patient presented ECOG1, thin, a painful abdomen in the epigastrium, and a palpable mass. CT of the abdomen showed a lesion of 11.2×9.7×8.1cm in the left hypochondrium with contiguous gastric wall and no metastases. Endoscopy with ulcerated lesion in the gastric body and adenocarcinoma biopsy. Colonoscopy with splenic ulcerous lesion in the colon, of the same gastric histology, and elevated low rectus lesion, endoscopically resected, with pathology compatible with neuroendocrine tumor, free margins. Normal tumor markers. The patient developed with an obstructive condition and submitted exploratory laparotomy with findings of massive obstructive lesion in the splenic angle of the colon with invasion of the gastric wall and tail of the pancreas. Multivisceral resection with subtotal colectomy, partial gastrectomy and caudal pancreatectomy in monoblock associated with terminal ileostomy. She presented satisfactory evolution and was discharged on the 7th day after surgery. Discussion: Invasive colorectal cancer that contiguously affects adjacent structures without distant metastasis occurs in 5 to 18% of cases. They are adequately treated with monobloc resection and free margins, since recurrence after such resection is around 18%, while adhesion violation can reach 69%. Limited resection for locally invasive tumors results in 5% survival at 5 years, a low rate compared to extended resection, which has a 33% survival rate, showing that the case was satisfactorily managed to gain survival. In relation to neuroendocrine rectal tumor is rare and approximately 10% may be associated with other colonic neoplasia, the treatment of superficial lesions is usually endoscopic, as was the case. Concluding remarks: Although postoperative morbidity is higher, a one-piece approach reduces the incidence of bleeding and contributes to better outcomes, showing local recurrence rates, disease-free period, and overall survival similar to cases that do not require multivisceral resection. The case is relevant because it presents invasion of structures such as stomach and pancreas, which are not common, and because there is a neuroendocrine synchronic tumor in the lower rectum. Multivisceral resection was important for the patient, since there is evidence of longer survival and lower local recurrence.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019