Extended Surgery with En Bloc Resection of the Right Common Iliac Vessels for Lymph Node Metastasis of Mucinous Colon Carcinoma: Report of a Case

Abstract

We report herein the case of a 63-year-old woman who underwent surgery for recurrent mucinous carcinoma of the cecum. Recurrent metastatic lymph nodes had invaded the right common iliac vessels and right ureter, but she had no distant metastases and no peritoneal dissemination. Extended surgery with en bloc resection of the right iliac vessels and right ureter, and femorofemoral bypass were performed. Postoperatively, several complications developed which were successfully treated by further operations. By 1 year after surgery, she had no recurrent tumors on radiological examination, suggesting that our aggressive surgery with resection of the invaded regional vessels had effectively removed the recurrent tumors. This procedure may therefore significantly prolong the survival time and improve the quality of life of such patients.

En bloc resection of abdominal aorta and paraaortic lymph node metastasis of sigmoid cancer

“…The first two reports describing extended curative surgery for metastatic lymph nodes of the colon with en bloc resection of the abdominal aorta were published in Japan [8,10,11]. Nishimura et al [12] reported combined aortectomy with dissection of recurrent paraaortic lymph nodes of sigmoid colon cancer in a 48-year-old woman four years after surgery for sigmoid colon cancer.…”

“…If tumor cells have invaded the regional vessels, lymphadenectomy alone cannot completely eradicate malignant tissue since cancer cells remain on the surface of regional vessels. While en bloc resection together with the invaded vessels can be curative, extended surgery, especially with resection of major blood vessels, is associated with higher rates of morbidity and mortality than palliative surgery [8].…”

“…Solitary lymph node metastasis is rare and lymph node recurrence is usually one of several metastases effecting other organs [7]. Moreover, distant apical lymph node metastasis close to major blood vessels indicates systemic disease, therefore aggressive surgery is generally not advocated [8].…”

In situ reconstruction of the external iliac artery and vein with autogenous vessels in a patient with rectosigmoid colon cancer invading the external iliac artery and vein: A Case Report

“…[1][2][3][4][5] However, the details of vessel reconstruction were not thoroughly discussed and consensus was not achieved. Colorectal cancer often invades the iliac artery, but after resection of the involved iliac artery, obtaining autogenous graft material for arterial reconstruction is difficult because of the large caliber of the iliac artery.…”

“…In such cases, en-block resection including involved vessels combined with extra-anatomic bypass using an artificial graft is generally considered. [1][2][3][4][5] However, if in situ reconstruction using an autogenous vessel is feasible, it may be more physiologic and can eliminate the risk of graft infection. We present our experience of successful in situ left external iliac artery (EIA) and vein (EIV) reconstruction without using an artificial graft during the radical resection of colorectal cancer invading the external iliac vessels.…”