How Surgery and Adapted Chemotherapy Helped One Patient Stay Recurrence-Free

In November 2017, a 53-year-old male patient arrived at IUHW Shioya Hospital in Yaita, Japan, with signs of rectal bleeding. Further investigation by contrast-enhanced computed tomography (CECT) uncovered two metastatic lesions in the liver—one measuring 10 mm in segment 3 and the other 7 mm in segment 4. This discovery confirmed a diagnosis of stage IV rectal cancer (pT3N2bM1) according to the American Joint Committee on Cancer TNM staging system.

Because of active bleeding from the primary rectal tumor, the medical team proceeded with a low anterior resection as the initial step. Pathological examination revealed a moderately differentiated adenocarcinoma, further solidifying the advanced staging. Despite a mild decline in respiratory function, the patient’s overall condition allowed for a second surgery on the liver. Two months after the first operation, imaging confirmed the absence of additional metastases, and a partial hepatectomy was successfully performed.

Following liver surgery, the patient embarked on a six-month chemotherapy plan consisting of FOLFOX (folinic acid, fluorouracil, and oxaliplatin). However, significant myelosuppression after three courses forced an early stop to that regimen. The treatment strategy then shifted to capecitabine monotherapy (3,600 mg/day), which the patient tolerated for four courses. This adjusted chemotherapy schedule completed the intended six-month post-hepatectomy treatment window.

Now, 1,826 days (five years) post-hepatectomy, the patient continues to live without any signs of disease recurrence. Regular follow-ups occur every 1–2 months at the outpatient clinic, where imaging and blood tests confirm his stable condition. His story underscores the importance of a flexible treatment plan when standard protocols become intolerable—ultimately leading to a sustained remission even after an advanced diagnosis.