Experience of transanal endoscopic microsurgery in the treatment of synchronous primary multiple colorectal cancer: a case report

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Abstract

INTRODUCTION: The incidence of primary multiple colorectal cancer ranges from 1% to 8%. In 50% of cases, synchronous malignant tumors are located in different segments of the colon, which requires expanding the scope of the operation to colectomy, colproctectomy or simultaneous resections of different segments of the colon.

The article presents a clinical case of a 65-year-old patient with rare and difficult to diagnose synchronous primary multiple colorectal cancer. Simultaneous laparoscopic right hemicolectomy with D2 lymphadenectomy and transanal endoscopic excision of the rectal tumor were performed in the treatment. As a result, it was possible to avoid low anterior resection of the rectum with a ‘switching-off’ stoma, achieve the fastest possible rehabilitation and the absence of complications in the postoperative period. It is worth noting, however, that the transanal stage took 90 minutes with relatively small tumor sizes, which is associated with the stage of mastering the technique and overcoming the learning curve.

CONCLUSION: Transanal endomicrosurgery is an effective and safe option for surgical treatment of rectal tumors.

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About the authors

Ivan S. Ignatov

I.M. Sechenov First Moscow State Medical University

Email: ignatov.mac93@mail.ru
ORCID iD: 0000-0002-8550-1909
SPIN-code: 4917-9697

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Alexander Yu. Ogoreltsev

Ryazan State Medical University; Regional Clinical Hospital

Email: proctologist@list.ru
ORCID iD: 0000-0002-1797-5563
SPIN-code: 8678-5289

MD, Cand. Sci. (Medicine)

Russian Federation, Ryazan; Ryazan

Yulia B. Li

I.M. Sechenov First Moscow State Medical University

Email: li_j94@mail.ru
ORCID iD: 0000-0002-4362-6762
SPIN-code: 5882-4327
Russian Federation, Moscow

Svetlana V. Snegur

Regional Clinical Hospital

Email: svsnegur@yandex.ru
ORCID iD: 0000-0002-0038-0109
SPIN-code: 8341-8588
Russian Federation, Ryazan

Svetlana S. Burmistrova

Ryazan State Medical University

Author for correspondence.
Email: Svetick.Burmistrova@yandex.ru
ORCID iD: 0000-0001-9331-6634
SPIN-code: 5627-1537
Russian Federation, Ryazan

Tatyana I. Leukhina

Ryazan State Medical University

Email: tlieukhina@mail.ru
ORCID iD: 0000-0002-3939-5850
SPIN-code: 4079-5250
Russian Federation, Ryazan

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Supplementary files

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2. Fig. 1. X-ray computed tomography of abdomen. Tumor of the right flank of colon (arrow).

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3. Fig. 2. A tool kit for transanal endomicrosurgery.

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4. Fig. 3. Marking of 5 mm resection margin.

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5. Fig. 4. Excision of the tumor with outlet to mesorectal tissue using the Harmonic apparatus.

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6. Fig. 5. Suturing of the rectal wall defect with V-lock.

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