Yoshikage Inoue, MD, Akiyoshi Kanazawa, PhD. Kitano Hospital
INTRODUCTION – Situs inversus totalis is a rare congenital abnormality. We successfully performed laparoscopic lower anterior resection for Rectal Cancer with Situs inversus totalis by creating a safe and oncologically sufficient strategy before and during surgery.
CASE PRESENTATION – A 68 year old man presented at our hospital with the diagnosis of Rectal cancer detected by lower endoscopy. Preoperative computed tomography showed Situs inversus totalis without lung or liver metastasis. The preoperative diagnosis was cStage3b (cT3, cN1, cM0). The benefit of laparoscopic surgery is most apparent for rectal surgery since the pelvic cavity is small, especially for men. Therefore, we performed laparoscopic lower anterior resection with lymph node dissection. Because the rectum is a bilaterally symmetric organ itself, surgery can be done if the lymph node dissection, which is the unsymmetrical part of surgery, can be performed safely. The surgical strategy consisted of image rehearsal with three dimensional CT angiography of inferior mesenteric artery preoperatively, lymph node dissection from the left side of the patient, and sufficient abruption of the mesorectum from the usual right side of the patient during surgery. The patient was discharged without any complications on postoperative day 9. Histological examination disclosed stage3c (pT3, pN2b, cM0). Three months after operation, he is taking adjuvant chemotherapy without recurrent rectal cancer.
CONCLUSION – Laparoscopic lower anterior resection for Rectal cancer with Situs inversus totalis can be considered as a feasible and safe procedure with a well-planned strategy.