Cyril Kamya, MD, Amos Zimmermann, MD, Joshua Hanson, MD, Victor Phuoc, MD
Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM (Drs. Kamya, Zimmermann, and Phuoc). Department of Pathology, University of New Mexico School Medicine, Albuquerque, NM (Dr. Hanson).
We report a case of a 58-y-old male with a metachronous abdominal wall metastasis secondary to colorectal cancer. The patient initially presented 2 y ago at an outside facility with stage IV (T4, N0, M1) sigmoid colon cancer with liver metastasis. Fine needle aspiration (FNA) was performed of the liver masses, located in segment 5, inferior segment 4B, and segment 2 and ranging between 1 and 3 cm in size. The patient subsequently underwent laparoscopic sigmoid colon resection with end colostomy creation. Following this, adjuvant chemotherapy was administered with five cycles of FOLFOX. Interval computed tomography (CT) scan following chemotherapy demonstrated a decrease in size of the larger liver masses. At our institution, an open total left hepatic lobectomy (hepatic segments 2, 3, and 4) and a partial right hepatectomy of hepatic segment 5 were performed. Twelve further cycles of adjuvant chemotherapy were then performed. One year after the sigmoid resection, robot-assisted colostomy closure with end-to-end, double-stapled coloproctostomy was then performed. A subsequent CT identified a small right liver lesion consistent with metastasis, and as such the patient underwent further cycles of chemotherapy. Following these cycles of chemotherapy, positron emission tomography/CT demonstrated a resolution of the liver recurrence; however, a hypermetabolic lesion at the former site of colostomy within left anterior rectus musculature was evident. This was confirmed on core needle biopsy to be adenocarcinoma of colon primary. Robotic-assisted resection of the abdominal wall metastasis was successfully performed.
Key Words: colorectal cancer recurrence, abdominal wall metastasis, metastectomy, robotic.