En Bloc Resection and Vascular Reconstruction for Cecal Cancer Involving the Right Common Iliac Artery and Inferior...

Complete resection with negative margins (R0) is associated with favorable outcomes in patients with locally advanced colorectal cancer. When tumors invade major vessels, such as the iliac artery or inferior vena cava, curative surgery requires vascular resection and reconstruction, which can be technically demanding.

An 88-year-old female presented with abdominal pain and was diagnosed with cecal cancer with para-aortic lymph node metastasis invading the right common iliac artery and inferior vena cava. After laparotomy confirmed resectability, femoro-femoral bypass was performed to preserve lower limb perfusion. This was followed by ileocecal resection with an en bloc resection of the right common iliac artery and partial removal of the inferior vena cava, right ureter, and ovary. Histopathological examination revealed a moderately differentiated adenocarcinoma staged as pT4b (ureter), N2a, and M1a (para-aortic lymph node), corresponding to stage IVa, with negative surgical margins. Her early postoperative course was uneventful, except for a central venous catheter-related infection and transient lower limb edema, both of which were managed conservatively. The patient was discharged on POD 35.

This case highlights that en bloc resection and vascular reconstruction for colorectal cancer involving major vessels-specifically the right common iliac artery and inferior vena cava-may be performed safely even in super-elderly patients, provided that careful preoperative planning and strict surgical field separation are implemented. Our experience suggests that advanced age alone need not automatically preclude curative-intent surgery when functional status is preserved and the patient strongly wishes to undergo treatment.