Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2019; 7(3): 335-339
Published online Feb 6, 2019. doi: 10.12998/wjcc.v7.i3.335
Successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy: A case report
Zhu-Lin Li, Zhen-Jun Wang, Jia-Gang Han, Yong Yang
Zhu-Lin Li, Zhen-Jun Wang, Jia-Gang Han, Yong Yang, Department of General Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing 100020, China
Author contributions: Wang ZJ designed the report; Han JG and Yang Y collected the patient’s clinical data; Li ZL and Han JG analyzed the data and wrote the paper.
Supported by National High-Tech R and D Program of China (863 Program), No. 2015AA033602; and Personnel Training Program of Beijing Chao-Yang Hospital Affiliated to Capital Medical University, No. CYXZ-2017-09.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhen-Jun Wang, MD, Professor, Department of General Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing 100020, China. drzhenjun@163.com
Telephone: +86-10-85231604 Fax: +86-10-85231604
Received: September 21, 2018
Peer-review started: September 21, 2018
First decision: November 5, 2018
Revised: November 28, 2018
Accepted: November 30, 2018
Article in press: December 1, 2018
Published online: February 6, 2019
Processing time: 129 Days and 17.4 Hours
Abstract
BACKGROUND

Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here, we report the successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy.

CASE SUMMARY

The patient was a 72-year-old man who was admitted with a chief complaint of abdominal pain for more than 1 mo. Computed tomography (CT) scanning revealed that there was a mass in the descending colon, which led to intestinal obstruction. On admission, a series of therapeutic measures, such as fasting and water deprivation, gastrointestinal decompression, total parenteral nutrition, and octreotide acetate, were taken to improve the obstructive symptoms. At the same time, a self-expandable metal stent was successfully placed across the stenosis, and a biopsy was obtained and diagnosed as adenocarcinoma. CT scanning 14 d after insertion of the stent revealed that the intestine was swollen significantly. Systemic chemotherapy with modified FOLFOX6 (mFOLFOX6) was administered. After two courses of mFOLFOX6, CT scanning showed clearly that swelling of the intestine was improved. Subsequently, the patient underwent left hemi-colectomy without stoma placement. The postoperative course was uneventful, and he has been disease-free for 6 mo after surgery.

CONCLUSION

This modified treatment strategy may provide an alternative therapy for patients with obstructing colonic cancers.

Keywords: Stent; Colorectal neoplasms; Intestinal obstruction; Chemotherapy; Case report

Core tip: As a bridge to surgery, the use of stents for potentially resectable colorectal cancers makes it possible to convert urgent to elective surgery. The European Society of Gastrointestinal Endoscopy guideline in 2014 recommended a 5-10 d time interval to operation. However, patients who experience a chronic obstruction are usually in a poor state because of inadequate nutritional intake, and the intestine is swollen. We modified the therapeutic strategy by prolonging the time interval to operation; two cycles of chemotherapy were administered before the operation.