Department of Oncology Surgery, King Hussein Cancer Center, Amman, Jordan.
Surg Laparosc Endosc Percutan Tech. 2020 Apr;30(2):e8-e12. doi: 10.1097/SLE.0000000000000753.
Colon cancer rarely presents with a gastrocolic fistula and resection, if feasible, is usually carried out by open surgery. The authors present the first literature case report of laparoscopic multivisceral resection for gastrocolic fistula secondary to locally advanced colon cancer.
A 54-year-old man presented with feculant vomiting, cachexia, and severe iron deficiency anemia. Investigations confirmed a large nonmetastatic splenic flexure colon cancer with fistulation into the stomach. After 10 weeks of nutritional support and laparoscopic defunctioning proximal transverse loop colostomy, we proceeded to laparoscopic extended left hemicolectomy with en bloc sleeve gastrectomy and partial splenectomy.
The procedure was completed laparoscopically (operating time, 400 min; blood loss, 150 mL). He was discharged on the 6th postoperative day after an uneventful recovery. Histology showed an R0 resection of a pT4N1a (1/45 lymph nodes involved) colon cancer with gastrocolic fistula.
Laparoscopic multivisceral en bloc R0 resection of locally advanced colon cancer with gastrocolic fistula can be accomplished safely in experienced hands.
结肠癌很少表现为胃肠瘘，且如果可行，通常通过开腹手术进行切除。作者报告了首例腹腔镜多脏器切除治疗局部晚期结肠癌继发胃肠瘘的文献病例。
一名 54 岁男性因粪便性呕吐、恶病质和严重缺铁性贫血就诊。检查证实存在大型非转移性脾曲结肠癌，且与胃瘘形成。在接受了 10 周的营养支持和腹腔镜预防性横结肠近端转流造口术之后，我们进行了腹腔镜下左半结肠扩大切除术，包括胃袖状切除术和部分脾切除术。
手术成功完成了腹腔镜下操作（手术时间 400 分钟，出血量 150 毫升）。患者术后恢复顺利，无并发症，于第 6 天出院。组织学检查显示，结肠肿瘤为 pT4N1a（1/45 个淋巴结受累）的 R0 切除，伴有胃肠瘘。
在有经验的医生手中，腹腔镜下多脏器整块 R0 切除治疗局部晚期结肠癌并发胃肠瘘是安全可行的。
