Long-Term Survival After Radical Resection of Rectal Cancer With Synchronous Solitary Rib Metastasis: A Case Report

Synchronous bone metastasis from rectal cancer is exceedingly uncommon, typically associated with poor prognosis, and lacks a standardized treatment strategy. We report the case of a 67-year-old woman who was asymptomatic and referred for evaluation after a positive fecal occult blood test at screening. Staging work-up revealed rectal cancer with a solitary synchronous metastasis in the left fourth rib. The rib tumor was resected with chest wall reconstruction for both diagnostic confirmation and local control, followed 52 days later by robot-assisted low anterior resection of the primary lesion. R0 resection was achieved for both sites. Considering the risk of occult systemic disease, adjuvant chemotherapy with capecitabine plus oxaliplatin (CAPOX) and bevacizumab was initiated, subsequently switched to capecitabine plus bevacizumab, and continued for two years. The patient remains disease-free five years after primary tumor resection. This case suggests that, in carefully selected patients with solitary synchronous bone metastasis from rectal cancer, combined radical resection and systemic therapy may provide long-term disease control and survival benefit.