Palliative Surgery Helps Restore Comfort and Quality of Life for Stage IV Colon Cancer Patient at Kailash Hospital

Advanced colon cancer patients with metastasis in the liver become especially difficult to treat in cases where the disease continues to progress even after systemic therapy and begins to cause intestinal obstruction. In such cases, the main goal may become that of providing palliation by addressing painful symptoms, restoring bowel movements and improving quality of life.

A 60-year-old man with metastatic colon cancer to the liver was on chemotherapy and targeted therapy when he began to have signs of intestinal obstruction. The patient was admitted at Kailash Hospital, Noida and well planned palliative surgery of diversion colostomy was performed.

Presentation of Symptoms (if any)

The patient presented with:

• Colicky abdominal pain
• Progressive abdominal distension
• Features suggestive of intestinal obstruction

On clinical examination, the abdomen was significantly distended, and the patient was also found to have pallor.

Given his history of metastatic colon cancer and new symptoms related to obstruction, he was evaluated in order to assess his condition.

Diagnosis

The patient was a known case of Stage IV colon cancer with liver metastasis and was receiving chemotherapy along with targeted therapy.

Routine blood investigations were performed as part of his preoperative assessment. A whole-body PET-CT scan demonstrated disease progression, with increased FDG avidity involving the known colonic growth and liver metastatic lesions.

The findings, combined with his symptoms of abdominal pain and distension, suggested progression of the disease with development of large bowel obstruction.

After evaluation, he was advised high-risk palliative surgery with diversion stoma to relieve the obstruction.

Condition Overview

In stage IV colon cancer, the cancer has already metastasized to distant organs like the liver. Chemotherapy and targeted therapy would be necessary as a systemic therapy to manage the advanced disease, but sometimes progressive disease may lead to complications at the local site.

In this case, obstruction of the bowel was the consequence of the enlarging colonic mass.

This case was especially challenging due to the patient having:

• Colorectal Cancer
• Multiple metastases to liver
• Ongoing progressive disease on systemic therapy
• Diabetes to be improved before operation

Continued treatment with Bevacizumab: A targeted therapy with significant surgical considerations including risks of gastrointestinal complications and wound healing

In such circumstances, extensive cancer removal may not always be appropriate or feasible. A palliative diversion procedure can instead bypass the obstructed segment of bowel, relieve symptoms, restore bowel function, and help the patient continue subsequent cancer treatment.

Treatment Plan

Considering the advanced stage of disease and the patient's obstructive symptoms, the surgical team planned a high-risk palliative procedure.

Before surgery, the patient was carefully optimized.

Preoperative Optimization

Because the patient had pallor, 2 units of packed red blood cells (PRBCs) were transfused before surgery.

His blood sugar levels were also optimized because of his underlying diabetes, helping reduce the risks associated with surgery and postoperative recovery.

Surgical Procedure

The patient underwent Exploratory Laparotomy with Transverse Colostomy under General Anaesthesia, performed by Dr. Manish Sahni, Consultant – Surgical Oncology.

During surgery, the findings included:

• A large obstructing growth involving the distal transverse colon, with significant dilatation of the bowel proximal to the obstruction.
• Multiple liver metastases, consistent with his advanced Stage IV disease.

Considering the metastatic disease and the palliative intent of the treatment, a transverse colostomy was performed to divert the fecal stream and relieve the obstruction rather than performing an extensive tumor resection.

Outcome and Follow-Up

Following surgery, the patient was monitored closely in the Surgical ICU for the first 24 hours.

His recovery progressed steadily:

• He was shifted from intensive postoperative monitoring after stabilization.
• Oral liquids were initiated on Postoperative Day 2.
• As the colostomy became functional, his diet was gradually advanced.
• Soft diet was subsequently introduced and tolerated.
• There were no reported major postoperative complications during his recovery.

The patient was discharged in a stable condition on Postoperative Day 6 with advice for continued oncological follow-up and further management of his metastatic disease.

Conclusion

This particular case demonstrates the significance of palliative surgery in cases of advanced Stage IV colon cancer when there is progressive disease leading to bowel obstruction and causing great discomfort to the patient along with inability to eat.

In this case, the goal was not a broad surgical excision of the tumor mass, but the relief of symptoms and normalization of the bowel function. The transverse colostomy helped to overcome the obstruction and the patient could start eating again and recover enough for further treatment of his cancer.

At last, the case under discussion brings attention to the necessity of careful preoperative optimization in high-risk cancer patients with diabetes, anemia, metastasis, and ongoing targeted therapy.

Clinical Significance

Palliative surgery may be very important to improve the quality of life of patients with advanced colon cancer. These procedures may help patients recover from acute complications and possibly tolerate subsequent systemic therapies needed for disease management by relieving obstruction and improving nutritional and functional status.