Open AccessRepeated laparoscopic resection of extra-regional lymph node metastasis after laparoscopic radical resection for rectal cancer
Author(s) -
Kazuhiro Sakamoto,
Makoto Takahashi,
Rina Takahashi,
Shingo Kawano,
Masaya Kawai,
Kiichi Sugimoto,
Hirohiko Kamiyama,
Yutaka Kojima,
Atsushi Okuzawa,
Yuichi Tomiki
Publication year - 2018
Publication title -
journal of minimal access surgery
Language(s) - English
Resource type - Journals
eISSN - 0972-9941
pISSN - 1998-3921
DOI - 10.4103/jmas.jmas_177_17
Subject(s) - medicine , dissection (medical) , lymph node , lymph , metastasis , surgery , stage (stratigraphy) , colorectal cancer , laparoscopic surgery , radiology , laparoscopy , cancer , paleontology , psychiatry , biology
Here, we report a case of repeated laparoscopic resection of extra-regional lymph node metastases in a patient after laparoscopic surgery for rectal cancer. A 72-year-old woman was diagnosed with upper rectal cancer and underwent laparoscopic low anterior resection and D3 dissection. The pathological stage was considered as T3, N2b, M0, Stage IIIC. Six months after the operation, positron emission tomography-computed tomography (PET-CT) showed fluorodeoxyglucose (FDG) accumulation in the infra-renal para-aortic lymph nodes (PALNs). Systemic chemotherapy was administered; however, chemotherapy was discontinued due to hemoptysis related to her pulmonary disease. Therefore, we performed laparoscopic PALN resection. Pathologically, one lymph node was diagnosed with a metastasis. Three months after the second operation, PET-CT identified FDG accumulation in the left lateral pelvic lymph nodes (LPLNs) and a PALN. Laparoscopic LPLN dissection and PALN resection through minilaparotomy were performed. Pathologically, lymph node metastases were diagnosed in both fields. Sixteen months after the 3 rd operation, there is no recurrence.