Challenging case of deficient mismatch repair right-sided locally advanced adenocarcinoma of the ascending colon with duodenal involvement: A case report including step-by-step video of operation

Alexander A J Grüter; Malaika S Vlug; Ide T Spaanderman; Adriaan D Bins; Tineke E Buffart; Jurriaan B Tuynman

doi:10.1016/j.ijscr.2023.109137

Challenging case of deficient mismatch repair right-sided locally advanced adenocarcinoma of the ascending colon with duodenal involvement: A case report including step-by-step video of operation

Int J Surg Case Rep. 2024 Jan:114:109137. doi: 10.1016/j.ijscr.2023.109137. Epub 2023 Dec 12.

Authors

Alexander A J Grüter¹, Malaika S Vlug², Ide T Spaanderman³, Adriaan D Bins³, Tineke E Buffart³, Jurriaan B Tuynman²

Affiliations

¹ Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands. Electronic address: a.gruter@amsterdamumc.nl.
² Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
³ Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands.

Abstract

Introduction and importance: Irresectable colon cancer presents a complex clinical challenge. Neoadjuvant immunotherapy has shown potential in improving resectability. Additionally, advancements in surgical techniques, including complete mesocolic excision (CME) with central vascular ligation (CVL), have contributed to better outcomes for right-sided colon cancer. This case report aims to demonstrate the successful laparoscopic resection of initial appearing irresectable colon cancer with suspected duodenal involvement.

Case presentation: A 70-year-old female presented with an irresectable mismatch repair deficient (dMMR) adenocarcinoma of the ascending colon with suspected duodenal ingrowth. Neoadjuvant treatment with pembrolizumab and ataluren resulted in a significant response, allowing for surgical resection. A laparoscopic right hemicolectomy with CME, including CVL, intracorporeal anastomosis and extraction through a Pfannenstiel incision, was performed. Additionally, the serosal layer of the duodenum was shaved after observing the absence of intraluminal invasion. Postoperatively, transient gastroparesis occurred, but overall outcomes were favourable.

Clinical discussion: This case emphasizes the potential of immunotherapy in improving resectability for irresectable dMMR colon cancer with suspected involvement of surrounding organs. The combination of neoadjuvant therapy and advanced surgical techniques, such as CME with CVL, shows promise in achieving favourable clinical outcomes. However, further studies are needed to validate the effectiveness and safety of this combined approach in a larger cohort of patients.

Conclusion: The successful laparoscopic resection of initially irresectable dMMR colon cancer with duodenal involvement, following neoadjuvant immunotherapy, demonstrated promising outcomes. This case advocates for further exploration of neoadjuvant treatments' efficacy, coupled with advanced surgical techniques, in managing locally advanced right-sided colon cancer.

Keywords: Case report; Deficient mismatch repair; Locally advanced cancer; Neoadjuvant therapy; Right hemicolectomy; Right-sided colon cancer.

Publication types

Case Reports