There are a growing number of reports of unresectable, advanced
colorectal cancer and multiorgan invasive
colorectal cancer for which extended surgery was avoided or a radical operation was performed after down-staging, or
tumor size reduction, was achieved by
chemotherapy. Here we describe a case of
sigmoid colon cancer (cStage IV) for which preoperative
chemotherapy improved the outcome of surgery. The patient was a 57-year-old man with
sigmoid colon cancer of sufficient size to block the passage of the
endoscope. The
cancer was found to be widely infiltrated and adherent to the peritoneum over the bladder, with effusion around the
tumor that made peritoneal disseminated
metastasis a strong possibility. Moreover, many regional and periaortic lymph nodes were swollen.
Sigmoid colon cancer at Stage IV was diagnosed. After preoperative
chemotherapy [mFOLFOX6+bevacizumab (Bev)] was administered,
tumor size decreased sufficiently to allow the
endoscope to pass through. The effusion around the
tumor disappeared, and lymph node swellings were reduced. The surgical findings revealed no evidence of peritoneal
metastasis, and
tumor adhesion to the peritoneum over the bladder was small, which limited the extent of combined peritonectomy. Ultimately, the histopathological diagnosis was Stage II,and histological evaluation of the
drug therapy effects was that the
tumor was then Grade 1b. Although clinical studies are currently conducted on preoperative
chemotherapy for locally advanced
colorectal cancer, preoperative
chemotherapy is not established as standard treatment due to lack of clear evidence. The evaluation of the usefulness of preoperative
chemotherapy is warrants future clinical studies.