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Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision.

Aljiffry M, Alrajraji M, Al-Sabah S, Hassanain M - Saudi J Gastroenterol (2014 Sep-Oct)

Bottom Line: Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer.The operative time was 370 min and estimated blood loss was 400 mL.Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

ABSTRACT
Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood loss was 400 mL. Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation. A laparoscopic approach utilizing a Pfannenstiel extraction incision may present an advantageous and attractive option for simultaneous laparoscopic rectal and liver resection in selected patients with the aim of improving short-term outcomes.

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Postoperative CT of the liver
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Figure 2: Postoperative CT of the liver

Mentions: This is a case of a 51-year-old man, diagnosed with rectal adenocarcinoma. The patient did not have any pertinent past surgical or medical history. Presenting symptom was episodes of blood in his stool. Upon rectal examination and rigid proctosigmoidoscopy, he was found to have a tumor at 6 cm from the anal verge. An endoscopic rectal ultrasound was done showing the presence of a rectal tumor extending to the perirectal fat (uT3), it was later on confirmed by a pelvic magnetic resonance imaging, which also revealed the presence of a suspicious 9 mm lymph node in the mesorectum. A positron emission tomography–computed tomography scan showed the presence of a single hepatic metastasis in the left lobe of the liver (segments 2/3) measuring 4 × 3 cm Figure 1. Laboratory tests indicated an elevated Carcinoembryonic antigen (CEA) 27.4 μg/L, whereas the rest of the blood test results were within normal limits. He received six cycles of neoadjuvant chemotherapy (FOLFOX + bevacizumab), followed by a short course of pelvic radiation (25 Gy in 5 daily fractions). Afterward he underwent a one-stage laparoscopic liver and rectal cancer resection followed by adjuvant chemotherapy (FOLFOX + bevacizumab). Pathology of the resected specimens showed moderately to poorly differentiated adenocarcinoma for both the rectum and the liver with negative margins. However, one of 14 mesorectal lymph nodes was positive. The estimated blood loss was 400 mL and the operative time was 370 min. Postoperatively the patient required parenteral analgesia for 48 h, and resumed a normal diet on postoperative day 3 and was discharged on postoperative day 7. At 1-year follow up, the patient had no evidence of recurrence Figure 2.


Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision.

Aljiffry M, Alrajraji M, Al-Sabah S, Hassanain M - Saudi J Gastroenterol (2014 Sep-Oct)

Postoperative CT of the liver
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4196348&req=5

Figure 2: Postoperative CT of the liver
Mentions: This is a case of a 51-year-old man, diagnosed with rectal adenocarcinoma. The patient did not have any pertinent past surgical or medical history. Presenting symptom was episodes of blood in his stool. Upon rectal examination and rigid proctosigmoidoscopy, he was found to have a tumor at 6 cm from the anal verge. An endoscopic rectal ultrasound was done showing the presence of a rectal tumor extending to the perirectal fat (uT3), it was later on confirmed by a pelvic magnetic resonance imaging, which also revealed the presence of a suspicious 9 mm lymph node in the mesorectum. A positron emission tomography–computed tomography scan showed the presence of a single hepatic metastasis in the left lobe of the liver (segments 2/3) measuring 4 × 3 cm Figure 1. Laboratory tests indicated an elevated Carcinoembryonic antigen (CEA) 27.4 μg/L, whereas the rest of the blood test results were within normal limits. He received six cycles of neoadjuvant chemotherapy (FOLFOX + bevacizumab), followed by a short course of pelvic radiation (25 Gy in 5 daily fractions). Afterward he underwent a one-stage laparoscopic liver and rectal cancer resection followed by adjuvant chemotherapy (FOLFOX + bevacizumab). Pathology of the resected specimens showed moderately to poorly differentiated adenocarcinoma for both the rectum and the liver with negative margins. However, one of 14 mesorectal lymph nodes was positive. The estimated blood loss was 400 mL and the operative time was 370 min. Postoperatively the patient required parenteral analgesia for 48 h, and resumed a normal diet on postoperative day 3 and was discharged on postoperative day 7. At 1-year follow up, the patient had no evidence of recurrence Figure 2.

Bottom Line: Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer.The operative time was 370 min and estimated blood loss was 400 mL.Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

ABSTRACT
Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood loss was 400 mL. Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation. A laparoscopic approach utilizing a Pfannenstiel extraction incision may present an advantageous and attractive option for simultaneous laparoscopic rectal and liver resection in selected patients with the aim of improving short-term outcomes.

Show MeSH
Related in: MedlinePlus