Treatment Of Multiple Primary Colorectal Cancer By Segmental Resection: A Report Of 2 Cases And Literature Review

Objective and Background:Multiple primary colorectal cancer, also called repeat colorectal cancer, occurs in patients when there are two or more non-continuous primary malignant tumors inside large intestine at the same time. According to the time of onset, it is divided into synchronous carcinoma and metachronous carcinoma. It is synchronous carcinoma if the second cancer was diagnosed and the time is less than half a year from the first diagnosis time, but metachronous carcinoma if more than half a year. The preferred treatment of multiple primary colorectal cancers is surgical treatment and surgical resection is the only way to cure multiple primary colorectal cancers. For multiple primary colorectal cancers, the total colectomy is usually applied. But segmental resection of colon cancer radical not only ensures colorectal cancer radical resection of the lesions, but also to the largest extent, remains part of colon, which could be used as the alternative for total colectomy. In order to improve the cognition of segmental resection of colon cancer radical, authors provided a case report of synchronous carcinoma patient with three lesions undergoing segmental resection of colon cancer radical, and a case metachronous carcinoma patient undergoing surgery for the fourth time, followed by literatures review.Methods:Case presentation:1. A male patient with intermittent diarrhea for more than one year, medical examination showed no abnormality. Electronic colonoscopy suggested:narrow sigmoid colon cancer and pathological prompt adenocarcinoma. The abdominal CT enhancement showed:transverse colon hepatic flexure intussusception, the sigmoid colon and rectum placeholder, around the pelvic cavity, colon, liver and mesenteric roots existing multiple enlarged lymph nodes.2. A male patient, left lower quadrant abdominal ache for half a month, physical examination finds his right upper quadrant, left upper abdomen, lower abdomen, respectively had three surgery scars nearly 15 cm long, and the others was normal. Electronic colonoscopy showed a70 cm uplift colon lesions, the pathological prompt adenocarcinoma. CT prompted upper rectal wall thickening and proximal colon expansion. Patient had three times colorectal cancer radical surgeries respectively in 15 years ago,14 years ago and five years ago.Results:The first patient reported was definitely diagnosed as synchronous carcinoma. According to the situation of intraoperative exploration line of segmental resection of colon cancer radical:The right colon resection and the lymph node around resection and Dixon of colorectal cancer radical. After operation, the pathological prompted adenocarcinoma. The patient recovered well postoperation and was discharged in good physical condition. Postoperative follow-up was also normal. The second patient reported was definitely diagnosed as metachronous carcinoma, According to the situation of intraoperative exploration line of intestinal adhesion release and the left colon resection and the lymph node around resection. After operation, the pathological reported showed the diagnosis of adenocarcinoma. The patient recovered well postoperatively and was discharged in good physical condition, postoperative follow-up was also going on and now the patient is well.Conclusion:By the related literature review, multiple primary colorectal cancer, also called repeat colorectal cancer, occurs in patients when there are two or more discontinuous primary malignant tumors inside large intestine at the same time. The preferred treatment is surgical, but specific operation method choice should be based on tumor location, spacing, size, basic condition of the patient’s age and comprehensive consideration. Preoperative colonoscopy examination, imaging examination and intraoperative exploration played an important role in operation scheme. Postoperative pathology can finally confirm multiple primary colorectal cancer (MPCC). As compared to total colectomy(TC), segmental resection of colon cancer radical (SRCCR) is considered as a new alternative surgical technique with fewer complications.