Background: Colorectal cancer is the second leading cause of cancer deaths in the United States. Synchronous cancers occur rarely, representing approximately 3.5% of all colorectal cancers. When compared to open colectomies, laparoscopy has been shown to have similar oncologic outcomes with shorter hospital stays and lower 30-day mortality. Additionally, intraoperative fluorescence angiography (IFA) provides an objective assessment of bowel and anastomotic perfusion.

Case Presentation: Here we present the case of a 74-year-old lady who had synchronous ascending and sigmoid colon adenocarcinomas, treated with a laparoscopic resection. She initially underwent a colonoscopy for evaluation of symptomatic anemia which revealed an ascending colon adenocarcinoma. The bowel prep was poor however, and repeat colonoscopy revealed a synchronous adenocarcinoma in the sigmoid colon. We performed a laparoscopic total abdominal colectomy with primary end-to-end ileorectal anastomosis and IFA with indocyanine green (ICG). The procedure was successfully completed laparoscopically. A total of 8 ports were used. The extraction site incision measured 6cm. IFA with ICG showed good perfusion of the small bowel conduit and ileorectal anastomosis. Final pathology revealed a right colonic well-differentiated pT2 adenocarcinoma (16.5cm proximal margin), a moderately differentiated pT2 distal sigmoid colon adenocarcinoma (7.5cm distal margin), and 48 benign lymph nodes. These findings represented an optimal oncologic resection with adequate lymph node harvest and margin status. The patient recovered well and was ready for discharge home on postoperative day 4 without need for narcotics. She continues to be well 4 months after surgery.

Discussion: Assessment for synchronous lesions is critical in the evaluation of colorectal cancer patients. This case highlights a rare case of synchronous colon cancers and exemplifies the advantages of laparoscopic technique. It also illustrates the utility of intraoperative bowel perfusion assessment with fluorescence angiography, which has been associated with lower anastomotic leak rates.


Minimally Invasive Treatment of Synchronous Colon Cancers

Clinical Vignettes | Colon and Rectal Surgery

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