A Patient with Descending Colon Cancer and Concurrent Abdominal Aortic Aneurysm who Showed Hemodynamic Changes and was Treated with Laparoscopic Surgery

Abstract

In laparoscopic surgery for descending colon cancer with a concurrent abdominal aortic aneurysm (AAA), attention must be paid to the mobilization of the colon and to perfusion through the anastomosis. An 83-year-old man was diagnosed with descending colon cancer (cT3N0M0 : cStage IIa), and surgery was scheduled, but preoperative computed tomography showed a saccular AAA with a diameter of 51 mm. It was therefore decided to perform the surgery in two stages. Stent graft insertion (endovascular aneurysm repair, EVAR) was performed first, with laparoscopic colectomy carried out one month later. To avoid damaging the AAA, the medial approach was not used ; the left colon was mobilized from the lateral and cranial sides, and resection and reconstruction were performed via a small abdominal incision. Given the perfusion through the anastomosis, only D1 lymph node dissection was performed. There were no major complications, and the patient was discharged on postoperative Day 14. The case of a patient in whom AAA and descending colon cancer were discovered simultaneously, who was treated by two-stage surgery consisting of EVAR and subsequent laparoscopic colectomy, is presented. It was possible to avoid intraoperative damage and suture failure by being careful of the AAA during colon mobilization and deciding on the extent of resection in light of changes in perfusion associated with post-EVAR inferior mesenteric artery occlusion.