Complete Response in a Patient with Obstructing Locally Advanced Rectal Cancer After Staged Multimodal Therapy

Abstract

Introduction: Managing patients with obstructing locally advanced rectal cancer (LARC) is challenging. A planned stoma is a feasible approach; however, it may result in treatment delay.^1,2 The emergence of new drugs and the identification of novel molecular pathways have the potential to revolutionize the management and treatment response of these patients.³ The authors presented a case of obstructing LARC managed with a staged multimodal approach based on immune neoadjuvant therapy (NAT) and stoma-resection-reversal strategy.⁴

Materials and Methods:

A 64-year-old man presented with constipation for 3 months. Colonoscopy showed the tumor was 15 cm from the anus, causing luminal obstruction. Pathological biopsy revealed a moderately differentiated adenocarcinoma with microsatellite stability. Pelvic magnetic resonance imaging and positron emission tomography-computed tomography showed the upper rectal tumor invaded the visceral peritoneum, accompanied by enlarged mesenteric lymph nodes (cT4aN2bM0). Following several multidisciplinary team discussions for oncological and functional feasibility, the patient underwent a staged multimodal therapy as follows: (1) laparoscopic transverse colostomy; (2) neoadjuvant therapy (pembrolizumab plus bevacizumab and CapeOx for four cycles; another cycle of CapeOx as bridging therapy); (3) laparoscopic total mesorectal excision; (4) adjuvant chemotherapy (three cycles of CapeOx); and (5) stoma reversal.

Results:

The interval time between colostomy and NAT was 4 weeks. The tumor achieved clinical partial response after NAT. The three postoperative courses were uneventful. Postoperative pathology showed a complete response. All margins were clear. The 6-month follow-up showed no tumor recurrence or metastasis, with good bowel function.

Conclusions:

In conclusion, in patients with obstructing LARC, staged multimodal therapy provides both oncological and functional benefits.

Disclosure Statement:

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Authors’ Contributions:

H.Z. had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: H.Z. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: All authors. Critical revision of the manuscript for important intellectual content: All authors. Supervision: H.Z.