Multivisceral and Iliac Vascular Resection for Recurrent Locally Advanced Colon Cancer: A Case Report

Case Report

Abstract

Locally advanced colorectal cancers with vascular invasion are rare and represent a major surgical challenge, achieving negative surgical margins often requires multivisceral and vascular resection. We report the case of a patient previously treated for sigmoid colon adenocarcinoma  followed by adjuvant chemotherapy. Four years later, she developed a recurrent right-sided colonic adenocarcinoma invading the iliac vessels. Initial surgery consisted of a right hemicolectomy; however, the procedure resulted in an R2 resection because of unexpected iliac vascular involvement, leaving residual tumor tissue marked with surgical clips. The patient subsequently received adjuvant FOLFOX chemotherapy.

Follow-up imaging, including CT angiography and PET scan, demonstrated a hypermetabolic residual tumor in the right iliac fossa encasing the right external and internal iliac arteries, involving the iliac veins and the right ureter, with secondary severe hydronephrosis and loss of right renal function. Following multidisciplinary team discussion, a curative surgical approach was undertaken. The patient underwent en bloc resection of the residual tumor with resection of the right iliac vascular pedicle, arterial and venous iliofemoral bypass reconstruction using a graft from the small saphenous vein, segmental small bowel resections with enteroenteric anastomosis, and total right nephrectomy.

This case highlights the importance of multidisciplinary management and aggressive surgical resection in selected patients with recurrent colorectal cancer involving major vascular structures. Despite the technical complexity and potential morbidity, vascular reconstruction associated with radical oncologic resection may improve long-term survival and quality of life in carefully selected patients.