What happened, in summary

A man in his 80s had been diagnosed 2 years earlier with ascending colon cancer after a colonoscopy for anemia. Initial staging found no distant metastases. He underwent a right hemicolectomy, and pathology showed a poorly differentiated adenocarcinoma with signet-ring features. The tumor had reached the outer surface of the colon and 4 of 13 lymph nodes contained cancer, but the surgical margins were clear. He then completed 8 cycles of 5-FU plus oxaliplatin and entered surveillance.

A later CT scan found a single enlarged nodule in the mesentery, the tissue that supports the bowel, near the previous surgical connection. The team believed this represented an isolated lymph-node recurrence. During surgery, recurrent tumor and several central mesenteric lymph nodes were found in tissue that had remained after the first operation. The mass was attached to nearby structures and had grown into tissue beside the sigmoid colon.

Surgeons performed a complete mesocolic excision, removing the involved mesentery, additional bowel segments and surrounding tissue together. Pathology found metastatic colon adenocarcinoma in 1 of 17 newly removed lymph nodes, with small tumor deposits extending into nearby soft tissue. The new surgical margins were negative.

His recovery was uncomplicated, and he went home 5 days after surgery. A temporary ileostomy was reversed 3 months later. At his last follow-up, 8 months after the salvage operation, his weight was stable and his energy was improving. The operation had been performed with curative intent.