Abstract
We report long-term survival in a case of rectal cancer with multiple remote lymph node metastases treated via a multidisciplinary approach, including surgery.
A 71-year-old man was admitted to our hospital with positive fecal occult blood. Upon further examination, we diagnosed rectal cancer with multiple, remote lymph node metastases, including in the Virchow, mediastinal, and para-aortic lymph nodes.
In April 2011, we started chemotherapy with FOLFIRI and panitumumab. After two courses, we observed penetration in the necrotic area of the tumor associated with tumor shrinkage, and the patient underwent a colostomy. After seven courses of neoadjuvant chemotherapy, we conducted high anterior resection in August 2011 because of obvious tumor shrinkage and disappearance of the metastatic lymph nodes. Histological examination of the resected specimens showed moderately to poorly differentiated adenocarcinoma, SE, ly2, v1, N1, H0, P0, Stage IIIa. We administered adjuvant chemotherapy for 12 courses, but we observed further disease in the para-aortic lymph node on positron emission tomography (PET) computed tomography (CT) examination. In March 2012, we performed a para-aortic lymph node dissection and colostomy closure. Histological examination of the resected specimens showed rectal cancer metastasis. We administered mFOLFOX-6 and bevacizumab for 12 courses from June 2012, because multiple para-aortic lymph node metastases were observed on the PET-CT examination. The patient refused continued chemotherapy in August 2012 ; however, he is alive without recurrence for 3 years and 3 months.
