Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall

<p>Abstract</p> <p>Backround</p> <p>Sigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall.</p> <p>Case presentation</p> <p>A 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0) sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided.</p> <p>Conclusion</p> <p>Metachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.</p

Total de linfonodos identificados após a ressecção do câncer colorretal Lymph nodes identification after colorectal cancer resection

RACIONAL: A base cirúrgica principal no tratamento do câncer colorretal é a remoção em bloco do tumor com adequadas margens proximal e distal, associada à remoção dos linfonodos mesentéricos. OBJETIVO: Avaliar fatores associados à quantidade de linfonodos encontrados em peças cirúrgicas de pacientes com câncer colorretal. MÉTODOS: Estudo retrospectivo, de pacientes consecutivos, operados com diagnóstico de adenocarcinoma colorretal. Foram excluídos aqueles submetidos ao tratamento cirúrgico paliativo. Os dados demográficos, operatórios e histopatológicos foram analisados utilizando os testes exato de Fisher, Qui-quadrado, Wilcoxon rank-sum e um modelo de regressão logística. RESULTADOS: No período de 2000 a 2008, foram operados 298 pacientes com câncer colorretal. Os dados incluídos na análise estavam disponíveis para 173 pacientes. Destes, 85 (49%) eram do sexo feminino e a idade mediana era de 65 (26-94) anos. A ressecção mais comum foi a colectomia esquerda (45%), seguida pela colectomia direita (23%). O número mediano de linfonodos isolados foi oito (0-67) e 33% dos pacientes tiveram 12 ou mais linfonodos identificados na peça cirúrgica. Os pacientes com idade menor que 50 anos e aqueles submetidos à coletomia direita obtiveram maior número de linfonodos isolados. CONCLUSÕES: A idade do paciente menor que 50 anos e o tipo de ressecção cirúrgica estão associados ao maior número de linfonodos encontrados nas peças cirúrgicas.<br>BACKGROUND: The main base in surgical treatment of colorectal cancer is en-bloc removal of the tumor with adequate proximal and distal margins, combined with the removal of lymph nodes. AIM: To evaluate factors associated with the number of lymph nodes found in surgical specimens from patients with colorectal cancer. METHODS: Analysis of a retrospective data of consecutive patients operated with a diagnosis of colorectal adenocarcinoma. Were excluded those undergoing palliative surgery. Demographic data, operative and histopathological findings were analyzed using the Fisher exact test, chi-square, Wilcoxon rank-sum and a logistic regression model. RESULTS: From 2000 to 2008, were operated 298 patients with colorectal cancer. The data included in the analysis were available for 173 patients. Of these, 85 (49%) were female and median age was 65 (26-94) years. The resection was the most common left colectomy (45%), followed by right colectomy (23%). The median number of lymph nodes were isolated from eight (0-67) and 33% of patients had 12 or more lymph nodes identified in surgical specimens. Patients younger than 50 years and those who underwent right colectomy had a greater number of lymph nodes isolated. CONCLUSIONS: Patient age less than 50 years and the type of surgical resection are associated with higher number of lymph nodes found in surgical specimens

The posterior approach for low retrorectal tumors in adults

Retrorectal tumors are uncommon in adults and arise in different tissues in the presacral space. The aim of this study is to evaluate early complete surgical resection by a perineal approach as the therapy-of-choice for tumors under the sacral promontory