Multiple rectal carcinomas successfully treated by intersphincteric resection with neoadjuvant therapy without radiation therapy: A case report

Abstract

Abstract Background In recent years, neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal resection has been the standard of care to prevent recurrence of locally advanced rectal cancer. However, radiotherapy is associated with several serious side effects in rectal cancer patients, including fecal incontinence, dysuria, sexual, dysfunction, and secondary cancer. Neoadjuvant chemotherapy (NAC) has demonstrated comparable efficacy to NACRT for advanced rectal cancer without these problematic side effects. Here, we present a case of advanced lower rectal cancer with multiple tumors that was successfully treated with NAC and intersphincteric resection. Case presentation A 56-year-old man presented with bloody stools and was diagnosed with lower rectal cancer cT3N1aM0 cStage IIIB and rectosigmoid cancer cT4aN1aM0 cStage IIIB following investigations by colonoscopy, whole-body contrast-enhanced computed tomography, and magnetic resonance imaging. Abdominoperineal resection was recommended but the patient refused, and thus NAC was proposed. Genetic testing revealed negativity for RAS and BRAF mutations, and hence five courses of mFOLFOX6 (fluorouracil, levofolinate, and oxaliplatin) and panitumumab regimen were administered. Subsequent imaging revealed a yellow clinical partial response for rectosigmoid cancer and a yellow clinical complete response for lower rectal cancer. Hospital tests showed no abnormal data, and the preoperative diagnosis was lower rectal cancer ycT0N0M0 ycStage 0 and sigmoid rectal cancer ycT2N0M0 ycStage I. Therefore, laparoscopic intersphincteric resection and a diverting stoma were performed at our institution 39 days after NAC was completed. The postoperative period was mostly uneventful apart from suture failure on postoperative day 12, and the patient was discharged on postoperative day 43. No cancer cells or lymph node metastasis were evident in postoperative pathology. Five months after surgery the colostomy was closed, and the patient had good anal function and no fecal incontinence 9 months after surgery. No recurrence had occurred 1 year after surgery. Conclusions NAC is efficacious in patients with multiple advanced rectal cancers and negates the requirement for abdominoperineal resection.