title: [Resection of the Right External Iliac Artery and Vein after Local Recurrence of Cecal Cancer].
abstract: A 62-year-old woman was admitted with abdominal pain and distention in July 2013. Computed tomography (CT) revealed a small bowel obstruction caused by an ileocecal tumor, and colonoscopy revealed a type 3 cecal tumor. Because an ileus tube was not effective to relieve her symptoms, she was transferred to the Department of Surgery for an emergency operation. Open resection of the ileocecal tumor along with the right ureter and psoas was performed. Histological examination showed that cancer cells were present in the radial margin. The patient was treated with a post-operative course of chemotherapy (capecitabine and oxaliplatin), but the level of carcinoembryonic antigen was increasing; positron emission tomography (PET) revealed a local cancer recurrence. Although the right external iliac artery and reconstructed right ureter were encased by the tumor, there were no signs of lymph node metastasis or distant metastasis. Because the tumor was localized, we decided to perform a re-excision. Intraoperatively, the right external iliac vein was difficult to separate from the tumor. Therefore, we resected the right ureter, kidney, and right external iliac artery and vein en bloc. The right external iliac artery and vein were replaced with grafts. Histopathologically, the reconstructed right ureter was completely invaded by the tumor, and cancer cells had invaded the nearby adventitia of the artery, but the surgical margin was negative. Four months after the second operation, peritoneal dissemination was detected on PET. The patient was followed-up in an outpatient clinic without chemotherapy.
authors.affiliation: Dept. of Surgery, Ogikubo Hospital.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Murai
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunugi
authors.forename: Ippei
authors.initials: I
authors.lastname: Oto
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kitasato
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Shimizu
authors.forename: Nobushige
authors.initials: N
authors.lastname: Yabe
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D002430:Cecal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007083:Iliac Artery / Q000473:pathology* / Q000601:surgery; D007084:Iliac Vein / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D010071:Oxaloacetates; D012008:Recurrence
chemical_list: D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil