Curative Resection of Locally Advanced Colon Cancer that Invading the Common Iliac Artery by Creating an Extra-Anatomical Arterial Bypass: A Case Report.

Introduction: Although complete resection during radical surgery is a crucial prognostic factor for locally advanced colorectal cancer, achieving it is often difficult when the tumor invades the iliac artery system. Herein, we report a successful case requiring resection of the common iliac vessels and vascular reconstruction using a femoral-femoral arterial bypass (F-F bypass), with a comparison to 4 previous cases involving F-F bypass.

Case presentation: A 47-year-old male presented with advanced cecal cancer involving the right external iliac artery and vein, right femoral nerve, right ureter, right psoas muscle, and right iliacus muscle. He received systemic chemotherapy with a vascular endothelial growth factor inhibitor for 20 months, and percutaneous drainage of a psoas abscess was performed at a previous hospital. Following these interventions, he was referred to our hospital for radical resection. An F-F bypass was performed prior to abdominal surgery, and en bloc resection of the cecal cancer was subsequently achieved, encompassing the common iliac vessels, femoral nerve, iliacus muscle, psoas muscle, and ureter. The patient showed no signs of recurrence, graft infection, or occlusion 2 years postoperatively.

Conclusions: This case demonstrates the potential of systemic chemotherapy followed by radical resection with extra-anatomical arterial bypass in achieving favorable long-term outcomes and satisfactory short-term results.