Contributed by Maurice R. Grant, MD and Joseph Huth, MD
Published on line in December 2000
This patient is a 69-year-old male with past medical history significant for infiltrating mucin secreting colonic adenocarcinoma arising in a villous adenoma diagnosed in 1991. The pathologic stage was T3, N1 and Duke's stage C. Peritoneal implants were identified and excised completely at the time of diagnosis. After the right hemicolectomy, the patient received 5-flourouracil based chemotherapy. In 1995, the patient developed a pelvic recurrence, positive for a metastatic mucinous moderately differentiated adenocarcinoma consistent with colonic primary. This was treated with chemotherapy and radiation therapy. The patient tolerated this well and was disease free until 1997. At the time, the patient was found to have a metastasis to the liver, bladder and rectum, again positive for the colonic primary. This was treated with cryoablation of the liver metastasis as well as resection of the liver and en bloc resection of the bladder and rectum with urinary diversion and diverting colostomy.
In January of this year, the patient was found to have recurrent hepatic metastatic disease that was slowly increasing in size by serial abdomen CT scans. The patient was otherwise asymptomatic without complaints of weight loss or change in appetite. The plan of care was for surgical resection of the hepatic lesion (presumed recurrent metastatic colonic adenocarcinoma). This operation was not for cure but for prolongation of survival.