Uncommon Rectal Adenocarcinoma Metastases

Česká verzia

Authors: J. Radoňak; L. Lakyová; T. Toporcer
Authors place of work: I. chirurgická klinika, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Košice, Fakultná nemocnica L. Pasteura, Košice, Slovenská republika, prednosta kliniky: prof. MUDr. Jozef Radoňak, CSc.
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 7, s. 441-445.
Category: Monothematic special - Original

Summary

Rectal cancer treatment has become multimodal as a result of significant advances in imaging diagnostic, in surgery technique of resection and in neo and adjuvant therapy. The aim of the case report was to present a successfully treated adenocarcinoma recti and adenocarcinoma of hepatal flexurae with recidivistic metastasis and an extremely rare intergrowth of the metastasis into venous system.

A 61 year old patient underwent low resection of recti accoring to Dixon because of well differentiated adenocarcinoma with classificaton T3N0M0. The patient was reoperated because of metastasis of adenocarcinoma in the abdominal wall (16x15x20 cm) after chemotherapy (FUL-5-fluorouracyl) and radiation dose of 50.4 Gy. The metastasis of abdominal wall was extirpated after another cycle of adjuvant therapy of FUL+Leukovorin. 26 months after the first operation, a new sessile polyp was found in the hepatal flexurae with histological finding of well differentiated adenocarcinoma. The patient underwent right hemicolectomy. Since lymphatic nodes were without metastasis, the patient was not indicated for chemotherapy. Two months later, the patient was admitted because of phlebothrombosis of left femoral vein. The patient underwent three reoperations with total extirpation of recidivistic tumor located in left thigh and received six cycles of Xeloda. Histological examination proved an intergrowth into great saphenous vein.

Authors did not come across a case in the literature with an intergrowth of metastasis into venous system with a five year survival of a patient. The patient from this case report has no local relapse and metastasis six years after the first operation.

Key words:
adenokarcinoma – tumor recti – metastasis into venous system – surgical treatment

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