Curative resection for locally advanced sigmoid colon cancer using neoadjuvant chemotherapy with FOLFOX plus panitumumab: A case report

Curative resection after percutaneous drainage followed by preoperative panitumumab monotherapy for locally advanced sigmoid colon cancer with intra-abdominal abscess: a case report

BACKGROUND

The gold standard treatment for locally advanced colon cancer is curative surgery followed by adjuvant chemotherapy, although this approach is associated with serious concerns, such as high recurrence rates and occasionally unnecessary oversurgery. Neoadjuvant chemotherapy may be a promising strategy for overcoming these issues. This study reports a case of a recurrence-free patient who underwent curative resection without significant organ dysfunction after preoperative chemotherapy for locally advanced sigmoid colon cancer. The tumor coexisted with a large intra-abdominal abscess, and the patient was quite frail at the first visit. We performed percutaneous drainage followed by preoperative panitumumab monotherapy, which yielded favorable outcomes.

CASE PRESENTATION

A 78-year-old frail woman was emergently transferred to our hospital with fever and abdominal pain. The diagnosis was locally advanced sigmoid colon cancer stage IIIC (T4bN2aM0) with a large intra-abdominal abscess. Immediate curative surgery was inappropriate, considering both tumor progression and the patient's frailty. We performed percutaneous drainage and colostomy construction, which was followed by seven cycles of preoperative panitumumab monotherapy without significant adverse events. After these treatments, inflammation was well controlled, and the tumor shrank remarkably. Furthermore, the patient recovered well from frailty; therefore, curative sigmoidectomy combined with resection of the left ovary and stoma closure was possible without any postoperative complications. The final pathological finding was T3N0M0, stage IIA disease. The patient was recurrence-free and had no significant organ dysfunction 21 months after the curative surgery.

CONCLUSIONS

The management of intra-abdominal abscesses and tailor-made preoperative chemotherapy based on the patient's frailty may have been the key factors responsible for the favorable course of this patient. Although further research is needed on the appropriateness of percutaneous drainage for malignancies related to intra-abdominal abscesses and preoperative panitumumab use for locally advanced colon cancer, the study findings can serve as reference for managing similar cases in an aging society.

Positive outcomes with neoadjuvant chemotherapy in the management of colovesical fistula in cancer: a case report and literature review

Colovesical fistula (CVF) is usually developed from colonic diverticulitis, followed by tumor. Traditional surgery is usually completed in one or more stages. For complex cancerous CVF, radical resection is more difficult. We report a 62-year-old male patient diagnosed with sigmoid colon cancer combined with sigmoid vesical fistula. In the course of treatment, in addition to conventional surgery, neoadjuvant chemotherapy (NAC) was innovatively used. The sigmoid tumor and fistula were significantly shrunken. Radical surgery achieved negative margins.

Surgical technique for the successful curative resection of locally advanced caecal cancer invading the external iliac artery: A case report

INTRODUCTION

Curative resection generally has a good prognosis if the tumor is a locally advanced colorectal tumor. However, resection of a primary tumor that has invaded the aortoiliac artery is controversial. Herein, we report a case of successful resection of advanced cecal cancer invading the external iliac artery.

CASE REPORT

A 29-year-old male patient had advanced cecal cancer invading the right external iliac artery and vein, right ureter, iliopsoas muscle, and sigmoid colon. We collected the patient's pre-/intra-/postoperative, clinical, and histological data. We reviewed the factors that may have contributed to curative resection without complications. We performed a palliative terminal ileum-sigmoid anastomosis for the prevention of intestinal obstruction. The patient received neoadjuvant chemotherapy, and the tumor patently regressed. After arterial reconstruction was performed with a femoral-femoral bypass, we performed radical resection: right hemicolectomy; partial sigmoidectomy; and partial resection of the right ureter, iliopsoas muscle, right testicular, and external iliac vessels. Pathologically, 99% of the tumor cells disappeared after chemotherapy. The patient was discharged on postoperative day 9. No recurrence has been noted 24 months after surgical resection, and the patient is receiving adjuvant chemotherapy.

CONCLUSIONS

Thus, we successfully resected advanced cecal cancer without complications. Reconstruction with femoral-femoral arterial bypass and neoadjuvant chemotherapy are useful methods for curative resection without complications.

Multivisceral Resection of Advanced Sigmoid Colon Cancer

Introduction: Colorectal cancer is one of the most common digestive malignancies, with a high mortality and morbidity rate, with nonspecific symptoms in the early stages and with a diagnosis in the advanced stage most often. In a significant percentage there are cases in which tumors with invasion in the border organs and multiorgan resections are required. In women, the invasion frequently occurs in the vagina, uterus and bladder.

Case report: We report the case of a 52-year-old woman, who presented in the Department of Surgery with the following complaints: fecaluria, pneumaturia, constipation and moderate abdominal pain, with onset of 4 months, in wich the patient neglected her symptoms. Following the investigations, a large tumor formation of sigmoid colon was diagnosed, with invasion in the uterus and bladder, with which it communicates through a 16mm fistula. The result of the biopsy was of low / moderate grade adenocarcinoma differentiated G2. Cystoscopy revealed bladder trigone invasion without being able to identify ureteral orifices, biopsy and urine cytology was also positive for cancer. The surgery was performed by a multidisciplinary team and a multivisceral resection was performed.

Conclusions: Multiorgan resections require trained, experienced teams, and oncological pathology raises special issues when it comes to radical visa. The management of invasive colonic tumors in the border organs must be established preoperatively, in agreement with the patient, because it involves problems related to the quality of life and the potential for survival.

Resection of "down-staged" advanced hepatocellular carcinoma after treatment with the VEGFR2 inhibitor apatinib: five cases report

Sorafenib and lenvatinib are currently standard treatments for advanced hepatocellular carcinoma (HCC); however, the therapeutic effect is unsatisfying. Indeed, very few patients with HCC under sorafenib treatment were eligible for surgery in the past ten years. In addition, there is no report of a patient with the opportunity to undergo radical resection after treatment with lenvatinib. Here, we describe five patients with advanced and unresectable HCC that were able to receive curative resection within 1 year of treatment with the tyrosine kinase inhibitor apatinib that selectively inhibits vascular endothelial growth factor receptor 2 (VEGFR2). The five patients with advanced and unresectable HCC were treated with apatinib (250 mg po, qd), and all the five patients obtained an objective response to the treatment, allowing for subsequent resection, and the second patient even obtained a pathological complete response. The latest follow-up date was August 20, 2019, and all patients were alive at the latest follow-up. The disease-free survival of the first patient was 13 months. Lung metastasis was found 12 months later after surgery for patient 5. The other three patients have no recurrence. This is the first report of a single drug with promising therapeutic effects in patients with advanced HCC within one year at a single center. Therefore, apatinib may be promising for some patients with locally advanced HCC to undergo radical resection and improve outcomes.

Laparoscopic Partial Resection of the Urinary Bladder for Colorectal Cancers With Suspected Urinary Bladder Invasion

Introduction

Although partial cystectomy has been performed by laparoscopy in patients with benign disease, there have only been a few reports regarding the laparoscopic partial resection of urinary bladder–adherent colorectal cancer. This study was conducted to evaluate the short-term surgical outcomes of laparoscopic partial resection of urinary bladder–adherent colorectal cancer.

Case presentation

Between April 2014 and February 2017, 6 patients with colorectal cancers that were adherent to the urinary bladder underwent laparoscopic colorectal cancer resection combined with partial cystectomy. Their surgical outcomes were reviewed retrospectively. The primary colorectal cancer was located in the sigmoid colon in 5 patients and the upper rectum in 1 patient. None of the patients required conversion to open surgery. The median duration of surgery was 411 minutes, and the median amount of intraoperative blood loss was 284 mL. In the patients with sigmoid colon cancer, the bladder was primarily closed under direct visualization via the small lower abdominal incision used to remove the tumor. In the patient with upper rectal cancer, the bladder was primarily closed laparoscopically. None of the patients demonstrated urinary leakage on retrograde cystography or anastomotic leakage, and there were no cases of perioperative mortality or morbidity. None of the patients developed recurrence of cancer at the median follow-up of 21 months.

Conclusion

Laparoscopic partial resection of urinary bladder–adherent colorectal cancer produces good short-term outcomes without increasing morbidity. Performing bladder closure under direct visualization via a small lower abdominal incision might be useful in selected patients.

Durable complete response in a patient with metastatic left-sided colon cancer treated with 5-fluorouracil, folinic acid, and irinotecan (FOLFIRI) and panitumumab: A case report

There are rare patients with metastatic colon cancer who experience dramatic and durable responses. Primary tumor location is a prognostic and potentially predictive factor and should be taken into consideration when deciding on the optimal first-line therapy to be used in combination with chemotherapy.

Efficacy of Neoadjuvant Chemotherapy with Capecitabine plus Oxaliplatin in the Treatment of Locally Advanced Sigmoid Colon Cancer Invading the Urinary Bladder: A Report of Three Cases

INTRODUCTION

We herein present three cases of locally advanced colon cancer (LACC) invading the urinary bladder, in whom combined neoadjuvant chemotherapy with surgical intervention was effective in disease control and preserving urinary function.

CASE PRESENTATION

Before neoadjuvant chemotherapy, all three cases underwent loop transverse colostomy for symptomatic colonic obstruction. Case 1: after 6 courses of capecitabine plus oxaliplatin (CAPOX), we performed sigmoid colectomy and partial resection of the bladder. The histological examination revealed pathological complete response (pCR). The final diagnosis was ypStage 0 (ypT0ypN0M0). Case 2: after 13 courses of CAPOX plus bevacizumab, we performed Hartmann's operation with partial resection of the bladder. The histological examination revealed pCR. The final diagnosis was ypStage 0 (ypT0ypN0M0). Case 3: after 6 courses of chemotherapy with CAPOX plus bevacizumab, we performed sigmoid colectomy and partial resection of the bladder. The pathological response was grade 1a according to the Japanese Classification of Colorectal Carcinoma. The final diagnosis was ypStage IIC (ypT4bypN0M0). All three cases underwent capecitabine-based adjuvant chemotherapy after radical surgery and patients are alive without recurrence.

CONCLUSION

Neoadjuvant chemotherapy with CAPOX with or without bevacizumab followed by radical surgery could be an effective treatment option for LACC invading the urinary bladder.