Metástasis gigante de cáncer colorrectal a nivel de pared abdominal

Metástasis gigante de cáncer colorrectal a nivel de pared abdominal

Giant abdominal wall metástasis from colorectal cancer

Santiago Alonso Gómez*, Ana Pilar Morante Perea*, Paula Frias Ventosa*, Sagrario Martínez Cortijo*

* Servicio de Cirugía General y Aparato Digestivo,
     Hospital Universitario Fundación de Alcorcón, Madrid, (España).

DOI: https://doi.org/10.14679/5195

Resumen:

Introducción: Las metástasis en pared abdominal secundarias a cáncer colorrectal (CCR) son infrecuentes, con una incidencia inferior al 1%. Su aparición como lesión única es excepcional y supone un importante reto diagnóstico y terapéutico.
Caso clínico: Mujer de 38 años intervenida en 2022 de adenocarcinoma de colon derecho mediante hemicolectomía laparoscópica y quimioterapia adyuvante. Consultó por crecimiento progresivo de una tumoración en hemiabdomen derecho. La exploración física evidenció una masa pétrea y poco móvil dependiente de la pared abdominal. El TC abdominopélvico mostró una lesión infiltrativa inicialmente sugestiva de tumor desmoide. La PAAF reveló células compatibles con adenocarcinoma metastásico. El estudio de extensión descartó enfermedad metastásica a distancia. Tras valoración multidisciplinar y prehabilitación con toxina botulínica, se realizó resección en bloque de una masa de 17 × 15 cm con márgenes oncológicos, incluyendo el músculo recto anterior derecho. La reconstrucción abdominal precisó técnica TAR bilateral y doble malla retromuscular. La evolución postoperatoria fue favorable.
Discusión: Las metástasis parietales de CCR son una forma excepcional de diseminación tumoral. Su diagnóstico diferencial incluye tumores desmoides y sarcomas. En pacientes seleccionados sin enfermedad sistémica, la resección radical asociada a reconstrucción compleja de pared abdominal puede proporcionar adecuado control local y potencial beneficio en supervivencia.
Palabras Clave: Cáncer colorrectal, Metástasis parietal, Pared abdominal, Reconstrucción abdominal, Cirugía oncológica, TAR bilateral.

Abstract:

Introduction: Abdominal wall metastases secondary to colorectal cancer (CRC) are rare, with an incidence below 1%. Their presentation as an isolated lesion is exceptional and represents a major diagnostic and therapeutic challenge.
Case report: A 38-year-old woman underwent laparoscopic right hemicolectomy with curative intent for right colon adenocarcinoma in 2022, followed by adjuvant chemotherapy. She later presented with progressive enlargement of a right-sided abdominal mass. Physical examination revealed a hard, poorly mobile lesion arising from the abdominal wall. Abdominopelvic CT demonstrated an infiltrative mass initially suggestive of a desmoid tumor. Fine-needle aspiration showed findings consistent with metastatic adenocarcinoma. Staging studies excluded distant metastatic disease. After multidisciplinary evaluation and preoperative botulinum toxin infiltration, en bloc resection of a 17 × 15 cm mass with oncological margins was performed, including resection of the right rectus abdominis muscle. Abdominal wall reconstruction required bilateral transversus abdominis release (TAR) and double retromuscular mesh placement. Postoperative recovery was uneventful.
Discussion: Abdominal wall metastases from CRC are an uncommon form of tumor spread. Differential diagnosis includes desmoid tumors and soft tissue sarcomas. In selected patients without systemic disease, radical surgical resection combined with complex abdominal wall reconstruction may achieve satisfactory local control and potential survival benefit.
Key words: Colorectal cancer, Abdominal wall metastasis, Abdominal wall, Abdominal wall reconstruction, Oncologic surgery, Bilateral TARy.

Bibliografía

1. 1. 1. Raveendranadh A, Goutham M, Gowda C, Hegde K, Monappa V, Rodrigues G. Anterior abdominal wall metastasis following curative resection and chemoradiation of rectal cancer masquerading as a desmoid tumour: a clinical conundrum. J Taibah Univ Med Sci. 2022;17(1):146-149.
      2. Silecchia G, Perrotta N, Giraudo G, et al. Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery. Dis Colon Rectum. 2002;45(9):1172-1177.
      3. Koyama R, Maeda Y, Minagawa N, Shinohara T, Hamada T. Laparoscopic resection of an abdominal wall metastasis 5 years after primary colorectal cancer resection. Case Rep Gastroenterol. 2019;13(1):78-84.
      4. Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O’Connell MJ. Wound recurrence following conventional treatment of colorectal cancer. A rare but perhaps underestimated problem. Dis Colon Rectum. 1996;39(2):200-207.
      5. Hughes ES, McDermott FT, Polglase AL, Johnson WR. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum. 1983;26(9):571-572.
      6. Zmora O, Weiss EG. Trocar site recurrence in laparoscopic surgery for colorectal cancer. Surg Endosc. 2001;15(7):788-793.
      7. Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061-3068.
      8. Bittencourt MJS, Imbiriba AA, Oliveira OA, Santos JEB. Cutaneous metastasis of colorectal cancer. An Bras Dermatol. 2018;93(6):884-886.
      9. Yezhelyev MV, Deigni O, Losken A. Management of full-thickness abdominal wall defects following tumor resection. Ann Plast Surg. 2012;69(2):186-191.
      10. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709-716.
      11. Ibarra-Hurtado TR, Nuno-Guzman CM, Echeagaray-Herrera JE, et al. Use of botulinum toxin type A before abdominal wall hernia reconstruction. World J Surg. 2009;33(12):2553-2556.
      12. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29-42.
      13. Coccolini F, Gheza F, Lotti M, et al. Peritoneal carcinomatosis. World Society of Emergency Surgery guidelines. World J Emerg Surg. 2013;8:2.
      14. Lambert LA. Looking up: recent advances in understanding and treating peritoneal carcinomatosis. CA Cancer J Clin. 2015;65(4):284-298.