A Case of Abdominal Wall Reconstruction with an Anterolateral Thigh Flap in Advanced Sigmoid Colon Cancer

Abstract

A 44-year-old woman was admitted to hospital with abdominal wall penetration of the sigmoid colon and was diagnosed as having sigmoid colon cancer, type 2, cT4b (involving the left inguinal region, bladder, and left ovary and fallopian tube), N1b, M0, cStage IIIc. Following infection control with percutaneous drainage, a diverting colostomy was created, and neoadjuvant chemotherapy was started. Four cycles of CAPOX chemotherapy were administered, resulting in tumor size reduction ; however, abdominal wall infiltration persisted. Subsequently, a laparoscopic sigmoid colectomy (with D3 lymphadenectomy), concomitant left adnexal resection, partial bladder resection, and abdominal wall reconstruction were performed. The abdominal wall defect (skin 7×7 cm, muscular layer 5×7 cm) was reconstructed using a pedicled anterolateral thigh flap (ALT). Flap viability was confirmed using indocyanine green (ICG) fluorescence angiography. The patient's postoperative course was uneventful, and the patient was discharged on the 11th day after surgery. In conclusion, the combined approach of preoperative chemotherapy and abdominal wall reconstruction using ALT proved to be valuable in achieving complete resection for sigmoid colon cancer with abdominal wall infiltration.