Clinical Implications from a Single-Center Study of Colorectal Adenocarcinoma in Transplant Recipients

Lim, Sun Min; Jung, Minkyu; Shin, Sang Joon; Baek, Se Jin; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Kim, Nam Kyu; Ahn, Joong Bae

doi:10.1159/000369254

Cited by 1 publication

(2 citation statements)

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“…The increased risk of CRC after kidney transplantation has been well documented. [ 10 – 12 ] Moreover, compared with the general population, CRC that are diagnosed in kidney transplant patients often display a more aggressive behavior, and the aggressive behavior is characterized by an earlier age of cancer diagnosis, [ 13 ] a more advanced cancer stage (American joint committee on cancer stage > II), [ 14 ] and a lower 5-year survival. [ 13 , 15 ] Interestingly, a significantly reduced risk of rectal cancer was observed in the transplant recipients when separated from colon cancer, [ 16 , 17 ] and it seems that the elevated risk of CRC was driven by excess of proximal colon cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies found surgeries exerted a positive effect on survival of transplant patients with CRC. [ 14 , 19 ] Theoretically, these patients were supposed to be more susceptible to perioperative complications. However, Krysa [ 20 ] assessed the outcome of 21 kidney transplant recipients undergoing elective colorectal surgery, and suggested the results were favorable, with no transplant rejection, low morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic assisted low anterior resection for advanced rectal cancer in a kidney transplant recipient

Xia

Chen²,

Yao³

et al. 2016

Medicine

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Introduction:Development of de novo malignancy has become a major cause of late mortality in solid organ transplant recipients. Surgery is currently the most important treatment of choice for transplant patients with resectable CRC. However, conventional open surgery represents a great risk to these high-risk patients. They seem to benefit more from laparoscopic surgery, based on the favorable oncological outcome and remarkable short-term advantages of this approach.Patient concerns:In this study, we have reported a case of a 50-year-old man who had underwent kidney transplantation for 4 years. He presented with recurrent hematochezia and frequent loose stools for 1 year, and consulted a doctor for recent progressive general malaise and weight loss.Diagnoses:Colonoscopy revealed a near-circumferential mass at the middle rectum about 8 cm from anal verge. Further biopsy confirmed a diagnosis of adenocarcinoma. Following computed tomography demonstrated peripheral lymph node metastasis, but no signs of distant metastasis.Interventions:The patient underwent a laparoscopic assisted low anterior resection with total mesorectal excision for rectal cancer. Concomitantly, a loop transverse colostomy was performed to prevent anastomotic leakage. The surgery was completed within 120 min with a blood loss of 100 mL, and immunosuppressive therapy was not stopped perioperatively. Considering the tumor stage of pT3N1M0, the patient also received adjuvant chemotherapy with a regimen of FOLFOX for 8 cycles.Outcomes:Anastomotic bleeding occurred in this patient about 4 h after surgery, and a control of hemorrhage per anus was performed timely. The following postoperative course was uneventful without any complications, and graft function stayed well. After 4 months of follow-up period, the patient was in a good condition. No evidences of local recurrence and distant metastasis were found.Conclusion:We have presented a case of successful laparoscopic resection for advanced rectal cancer in a kidney transplant recipient. We believe laparoscopic surgery for CRC in transplant recipients is technically feasible and oncologically safe, which could be a preferred option of surgical procedure in the near future.

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