Early peritoneal metastasis after laparoscopic incisional hernia repair secondary to colon cancer resection: A case report.

INTRODUCTION

and importance: We report a case of a patient who developed early peritoneal metastasis after laparoscopic incisional hernia repair secondary to curative colon cancer resection.

CASE PRESENTATION

A 77-year-old woman underwent ileocecal resection with open laparotomy for locally advanced cecal cancer. The pathological diagnosis was adenocarcinoma with T3N2aM0. Three months after the surgery, she developed incisional hernia at the midline incision site. After the completion of adjuvant chemotherapy, surveillance computed tomography (CT) showed no cancer recurrence. Her abdominal discomfort persisted because of incisional hernia, and thus we performed laparoscopic incisional hernia repair using the intraperitoneal onlay mesh technique at 11 months after the initial surgery.Five months after incisional hernia repair, CT showed multiple liver and peritoneal metastases. She was started on systemic chemotherapy. Two days after the first therapeutic infusion, she developed small bowel obstruction. We decided to perform palliative surgery with intestinal bypass. Exploratory laparoscopy revealed that the implanted mesh for incisional hernia repair was completely covered with multiple nodules of peritoneal metastasis. Two months after the bypass surgery, she resumed her chemotherapy, but CT showed significant progression of all recurrent lesions. She did not wish to continue further chemotherapy and decided to receive the best supportive care.

CLINICAL DISCUSSION

This case may raise important clinical questions regarding the indication and timing of incisional hernia repair for patients who are at high risk of cancer recurrence.

CONCLUSION

Incisional hernia repair must be performed in the absence of any possibility of cancer recurrence, particularly in the earlier follow-up period.