Total Minimally Invasive Curative Staged Resections After Induction Systemic Therapy for Metastatic Rectal Cancer

Background: Intensified systemic chemotherapy following minimally invasive surgery for patients with unresectable metastatic colorectal cancer is performed to achieve curative resection and improve quality of life. We report a case of initially unresectable rectal cancer with metastases treated with laparoscopic and thoracoscopic staged resections after triplet chemotherapy plus bevacizumab.

Case: A 71-year-old man was referred to our hospital to examine the cause of constipation. A circumferential adenocarcinoma with extramural invasion and lateral lymphadenopathy was identified in the lower rectum with simultaneous metastatic liver and lung tumors. Intensified triplet chemotherapy plus bevacizumab was conducted to treat oncologically unresectable rectal cancer to avoid positive radial margins during surgical resection. Eleven cycles of chemotherapy resulted in regression of the tumors with metastases. Laparoscopic low anterior resection with lateral lymph node dissection was performed. Three months later, laparoscopic liver resection of the posterosuperior segment was performed without complications. Finally, the patient underwent thoracoscopic-assisted pulmonary segmentectomy of the right basal lobe. All resected tumors had negative surgical margins, and the patient has been surviving without adjuvant chemotherapy.

Conclusion: Minimally invasive staged resection and intensified chemotherapy for the treatment of initially unresectable metastatic colorectal cancer should be performed by a skilled surgical team in coordination with a multidisciplinary team.