Zhao Huiying, Zhong Weixiang, Chen Dong, Cheng Xiaofei
Department of Colorectal Surgery.
Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2019 Apr;98(14):e15016. doi: 10.1097/MD.0000000000015016.
Isolated splenic metastasis from colorectal cancer is very rare, as metastatic colorectal cancer involving the spleen is usually a manifestation of widely disseminated disease. Splenectomy is the best therapeutic option for this entity and probably the only chance for radical cure.
A 73-year-old male presented with abdominal distension and dark red bloody stool of 6-month duration.
Synchronous isolated splenic metastasis from colorectal cancer.
Based on multidisciplinary team (MDT) mode, the patient underwent the primary hepatic flexure tumor resection due to his poor general condition. One month after surgery the patient began treatment with Xelox (capecitabine 1000 mg/m, oxaliplatin 130 mg/m) every 3 weeks. The patient underwent isolated splenic metastasis resection successfully by laparoscopic after four courses of chemotherapy.
The patient's postoperative course was uneventful and he completed four courses of postoperative chemotherapy using the original chemotherapy regimen Xelox (capecitabine 1000 mg/m, oxaliplatin 130 mg/m). The patient was subsequently followed up every 3 months and no signs of recurrence were noted in a recent examination.
To the best of our knowledge, this is the first case report of isolated splenic metastasis from colorectal cancer in China. It is also the first case in which treatment was overseen by an MDT. The possibility of splenic metastasis should be considered in cases in which colorectal cancer is associated with a splenic lesion, despite its rarity. Splenectomy and adjuvant chemotherapy are the optimal therapeutic approaches, as such an approach prolongs survival and palliates the disease.
结直肠癌孤立性脾转移非常罕见，因为结直肠癌累及脾脏通常是广泛播散性疾病的一种表现。脾切除术是针对该病症的最佳治疗选择，可能也是实现根治的唯一机会。
一名73岁男性，出现腹胀和暗红色血便6个月。
结直肠癌同步孤立性脾转移。
基于多学科团队（MDT）模式，由于患者全身状况较差，先行肝曲原发性肿瘤切除术。术后1个月，患者开始每3周接受一次希罗达（卡培他滨1000mg/m²，奥沙利铂130mg/m²）治疗。经过四个疗程化疗后，患者成功通过腹腔镜进行了孤立性脾转移瘤切除术。
患者术后恢复顺利，使用原化疗方案希罗达（卡培他滨1000mg/m²，奥沙利铂130mg/m²）完成了四个疗程的术后化疗。随后患者每3个月接受随访，近期检查未发现复发迹象。
据我们所知，这是中国首例结直肠癌孤立性脾转移的病例报告。这也是首例由多学科团队监督治疗的病例。尽管结直肠癌合并脾病变时出现脾转移的可能性很小，但仍应予以考虑。脾切除术和辅助化疗是最佳治疗方法，因为这种方法可延长生存期并缓解病情。
