Abe Kentaro, Nozawa Hiroaki, Hoshina Katsuyuki, Takayama Toshio, Sasaki Kazuhito, Murono Koji, Emoto Shigenobu, Yokoyama Yuichiro, Kaneko Kensuke, Shirasu Takuro, Abe Shinya, Nagai Yuzo, Kimura Masaru, Shinagawa Takahide, Tachikawa Yuichi, Okada Satoshi, Hinata Munetoshi, Takase Akiko, Ushiku Tetsuo, Ishihara Soichiro
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Vascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0159. Epub 2025 May 1.
Recurrent tumors in colorectal cancer may be removed along with adjacent blood vessels to achieve R0 resection. However, it remains unclear whether to aggressively perform this procedure because it may cause serious intraoperative or postoperative complications.
In Case 1, a 62-year-old man underwent radical surgery for rectosigmoid cancer. Three years later, computed tomography scans revealed a disseminated nodule near the left external iliac vessels. We resected the tumor and vessels that were reconstructed by bypass surgery. Histologically, the margins of the tumor were in contact with the adventitia of the vessels. In Case 2, a 63-year-old man underwent radical surgery for ascending colon cancer. A nodule was detected at the right iliac fossa 16 years later and appeared to invade the right femoral vessels. After systemic chemotherapy, the nodule was removed with partial resection of the right femoral artery and vein that were reconstructed by end-to-end anastomosis and bypass surgery, respectively. Histologically, the tumor was located 0.7 mm from the vessels. In Case 3, a 67-year-old woman underwent radical multivisceral resection for obstructive rectosigmoid cancer invading the adjacent organs. Fifteen months later, she developed local recurrence and subsequently received chemotherapy. She underwent en bloc resection of the tumor and the left internal iliac artery (IIA) near the bifurcation. The left external iliac artery was reconstructed by end-to-end anastomosis. Direct invasion of the IIA was proven histologically. In Case 4, a 74-year-old woman underwent radical surgery for ascending colon cancer with high microsatellite instability. Eight months later, a recurrent tumor was detected near the right external iliac vessels. After pembrolizumab and chemoradiotherapy, we resected the tumor and part of the external iliac vein; the defect was primarily closed with sutures. No viable tumor cells were found in the specimen. During the follow-up period (median: 52 months), 3 patients were alive without vascular surgery-related complications.
It is difficult to accurately evaluate whether a recurrent tumor from colorectal cancer directly invades vessels using preoperative imaging. However, the combined resection of recurrent tumor and vessels may be required to achieve R0 resection, considering a short distance even in invasion-negative cases.
结直肠癌复发肿瘤可连同相邻血管一并切除以实现R0切除。然而，对于是否积极实施该手术仍不明确，因为这可能会导致严重的术中或术后并发症。
病例1中，一名62岁男性接受了乙状结肠癌根治手术。三年后，计算机断层扫描显示左髂外血管附近有一个播散性结节。我们切除了肿瘤及通过搭桥手术重建的血管。组织学检查显示，肿瘤边缘与血管外膜接触。病例2中，一名63岁男性接受了升结肠癌根治手术。16年后，在右髂窝发现一个结节，似乎侵犯了右股血管。经过全身化疗后，切除了结节，并分别通过端端吻合和搭桥手术对部分右股动脉和静脉进行了重建。组织学检查显示，肿瘤距血管0.7毫米。病例3中，一名67岁女性因侵犯相邻器官的梗阻性乙状结肠癌接受了根治性多脏器切除。15个月后，她出现局部复发，随后接受化疗。她接受了肿瘤与分叉处附近的左髂内动脉（IIA）整块切除。左髂外动脉通过端端吻合进行了重建。组织学检查证实IIA有直接侵犯。病例4中，一名74岁女性因高微卫星不稳定性的升结肠癌接受了根治手术。八个月后，在右髂外血管附近发现复发性肿瘤。在使用帕博利珠单抗和放化疗后，我们切除了肿瘤及部分髂外静脉；缺损处用缝线进行了一期缝合。标本中未发现存活的肿瘤细胞。在随访期（中位时间：52个月），3例患者存活，无血管手术相关并发症。
术前影像学检查难以准确评估结直肠癌复发性肿瘤是否直接侵犯血管。然而，即使在侵犯阴性的病例中，考虑到距离较短，为实现R0切除可能仍需要联合切除复发性肿瘤和血管。
