Overcoming Stage IIIB Transverse Colon Cancer: A Five-Year Disease-Free Success Story

A 75-year-old male was referred to IUHW Shioya Hospital in Yaita, Japan, diagnosed with transverse colon cancer. Despite his diabetes (with a hemoglobin A1c of 6.8%), a contrast-enhanced CT (CECT) revealed no sign of distant metastasis. Surgeons proceeded with a transverse colon resection, and pathology confirmed a pT3N1M0, stage IIIB, moderately differentiated adenocarcinoma.

Post-surgery, the patient began six months (eight courses) of capecitabine at 3,600 mg/day to eliminate microscopic disease. For over a year, he followed a careful recovery plan. However, at 1 year and 8 months post-operation, imaging discovered three liver metastases in the right lobe and segment 4 (S4), measuring up to 27×21 mm. With an indocyanine green retention rate at 15 minutes (ICG-R15) of 14%, his liver function was deemed sufficient for a subsequent surgical intervention.

Before surgery, the patient underwent two courses (one month) of FOLFOX plus bevacizumab—this regimen included folinic acid (200 mg/m²), fluorouracil (400 mg/m² bolus, 2,400 mg/m² continuous infusion), oxaliplatin (85 mg/m²), and bevacizumab (5 mg/kg). This combination aimed to shrink the metastatic lesions and enhance the likelihood of a successful surgical outcome. Doctors performed a partial right-posterior segmentectomy alongside a local resection in S4 to remove the metastases.

Since that hepatectomy, the patient has experienced no recurrence for an impressive 2,035 days (over five years). Follow-up visits at the outpatient clinic every one to two months have repeatedly shown clear imaging, reflecting the durable success of his integrative treatment approach. His case underscores the importance of regular screening, swift intervention for liver metastases, and the use of tailored chemotherapy protocols to address high-risk colon cancer effectively.