Repeated laparoscopic resection of extra-regional lymph node metastasis after laparoscopic radical resection for rectal cancer

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  • Kazuhiro Sakamoto
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Makoto Takahashi
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Rina Takahashi
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Shingo Kawano
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Masaya Kawai
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Kiichi Sugimoto
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Hirohiko Kamiyama
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Yutaka Kojima
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Atsushi Okuzawa
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
  • Yuichi Tomiki
    Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan

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<jats:p>Here, we report a case of repeated laparoscopic resection of extra-regional lymph node metastases in a patient after laparoscopic surgery for rectal cancer. A 72-year-old woman was diagnosed with upper rectal cancer and underwent laparoscopic low anterior resection and D3 dissection. The pathological stage was considered as T3, N2b, M0, Stage IIIC. Six months after the operation, positron emission tomography-computed tomography (PET-CT) showed fluorodeoxyglucose (FDG) accumulation in the infra-renal para-aortic lymph nodes (PALNs). Systemic chemotherapy was administered; however, chemotherapy was discontinued due to hemoptysis related to her pulmonary disease. Therefore, we performed laparoscopic PALN resection. Pathologically, one lymph node was diagnosed with a metastasis. Three months after the second operation, PET-CT identified FDG accumulation in the left lateral pelvic lymph nodes (LPLNs) and a PALN. Laparoscopic LPLN dissection and PALN resection through minilaparotomy were performed. Pathologically, lymph node metastases were diagnosed in both fields. Sixteen months after the 3<jats:sup>rd</jats:sup> operation, there is no recurrence.</jats:p>

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