A Case of Rectal Submucosal Cancer with Negative Vascular Invasion and Lateral Lymph Node Metastases

Abstract

The case of a 66-year-old man in whom colonoscopy showed a 20-mm 0-IIa + IIc lesion on the left wall of the rectum (Rb) is presented. When observed under normal light, the folds were concentrated, and under narrow-band imaging (NBI), the surface structure disappeared, and the microvascular structure was irregular. Endoscopic ultrasonography showed massive infiltration of the three layers by tumor, which led to a diagnosis of deep submucosal (SM) invasion. Pelvic MRI showed swelling of a lymph node with a major axis of 10 mm in the left obturator area and a high signal intensity on diffusion-weighted imaging. A diagnosis of T1bN3M0 cStage IIIb was made, and a laparoscopic intersphincteric rectal resection, left lymph node dissection, and ileostomy were performed. The patient was discharged on the 16th postoperative day. Pathological results were pT1b (1750 μm), ly0, v0, sprouting (-), N3 [(# 251 (1/4), # 283 (2/4)], pStage IIIb. CapeOX therapy was started as adjuvant chemotherapy, and the patient continues to be followed.