Treatment of advanced rectal cancer in a patient after combined pancreas-kidney transplantation.
BACKGROUND
Organ transplantation is a standard procedure today. Due to immunosuppressive drugs and increasing survival after organ transplantation, patients with transplanted organs carry an increased risk of developing malignant tumours. Accordingly, more patients with malignant tumours after transplantation will be faced by general or oncology surgeons. We report the case of a 48-year-old patient with advanced rectal cancer 6.5 years after pancreas-kidney-transplantation for type I diabetes.


METHODS
The patient was treated with neo-adjuvant radio-chemotherapy, followed by low anterior rectal resection with total mesorectal excision. Consecutively, a solitary hepatic metastasis, a solitary pulmonary metastasis and a chest wall metastasis were resected over the course of 13 months.


RESULTS
The patient eventually died of metastasized cancer 32 months after therapy had been initiated, his organ grafts functioning well until his death.


CONCLUSIONS
Our case report provides evidence that transplantation patients should receive standard oncology treatment, including neo-adjuvant treatment, so long as their general condition and organ graft functions allow us to do so, although a higher degree of morbidity might be encountered.
Department of General, Visceral and Transplantation Surgery, University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. tilman.zittel@med.uni-tuebingen.de
T T
TT
Zittel
C F R
CF
Mehl
U
U
Reichmann
H D
HD
Becker
E C
EC
Jehle
D000328:Adult; D017024:Chemotherapy, Adjuvant; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D016030:Kidney Transplantation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D020360:Neoadjuvant Therapy; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000601:surgery*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D014057:Tomography, X-Ray Computed