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Updated: May 12, 2025
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Published on: October 29, 2014
Rare Case of Additional Ileocecal Resection for Ascending Colon Cancer with R1 Resection due to Advanced Perineural
Yoshiaki Kanemoto1, Tomonari Amano2, Tomohiro Kurokawa1
1Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan.
Advanced lateral extension of perineural invasion (PNI) in colorectal cancer necessitates prompt additional resection. This rare case highlights the challenge of preventing positive margins and emphasizes the importance of further surgery and adjuvant therapy to reduce recurrence risk.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Perineural invasion (PNI) is a significant prognostic factor in colorectal cancer.
- Advanced PNI can lead to positive surgical margins, complicating treatment.
Observation:
- A 67-year-old woman presented with adenocarcinoma and extensive PNI along the ileum.
- Initial ileocecal resection resulted in R1 resection due to positive oral margins from PNI.
- A subsequent anastomotic resection achieved R0 status with negative margins.
Findings:
- The case demonstrates a rare instance of advanced lateral PNI requiring re-resection.
- Pathological examination confirmed residual adenocarcinoma infiltration within the intermuscular plexus after the second surgery.
Implications:
- Preventing R1 resection from advanced PNI is challenging due to its nature and the need to preserve bowel function.
- Prompt additional resection and adjuvant therapy are crucial for minimizing recurrence risk in such cases.
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