[Uncommon rectal adenocarcinoma metastases]

Area of Science:

• Oncology
• Vascular Surgery
• Gastroenterology

Background:

• Rectal cancer treatment has evolved into a multimodal approach, integrating advanced diagnostics, surgical techniques, and neoadjuvant/adjuvant therapies.
• Multidisciplinary care is crucial for managing complex rectal cancer cases, especially those with metastatic disease.

Observation:

• A 61-year-old patient presented with well-differentiated rectal adenocarcinoma (T3N0M0), treated with low anterior resection.
• The patient developed recurrent abdominal wall metastasis after initial chemotherapy (5-fluorouracil) and radiation (50.4 Gy), requiring surgical extirpation and further adjuvant therapy.
• A secondary adenocarcinoma was diagnosed in the hepatic flexure 26 months post-surgery, treated with right hemicolectomy. Subsequently, the patient experienced left femoral vein phlebothrombosis due to tumor recurrence with venous system involvement.

Findings:

• Histological examination confirmed metastasis invading the great saphenous vein, an extremely rare occurrence.
• The patient underwent multiple reoperations for tumor extirpation and received chemotherapy (Xeloda).
• Remarkably, the patient survived for six years post-initial operation without local relapse or metastasis.

Implications:

• This case highlights the possibility of successful long-term survival even with rare venous system metastasis in rectal cancer.
• It underscores the importance of vigilant surveillance and aggressive multimodal treatment strategies for recurrent and metastatic rectal cancer.
• The successful management of this rare presentation may inform future treatment protocols for similar complex oncological cases.