VM64 - Robotic Right Colectomy following Neoadjuvant Chemoimmunotherapy for Locally Invasive Colon Cancer

ONGOING VIDEOS

Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Ashley Toussaint, DO

General Surgery Resident
Rutgers Robert Wood Johnson Medical School
Somerset, NJ, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

RK

Risa N. Kiernan, DO, MS

Resident
Rutgers - Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States

Disclosure information not submitted.
HS

Hussam Shwaib, MD, MAS

General Surgery Resident
Rutgers Robert Wood Johnson, Department of Surgery
Old Bridge, New Jersey, United States

Disclosure information not submitted.
Andrew Hu, MD

Mark Kusek Colorectal Research Fellow
UMass Chan Medical School
Worcester, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
BS

Brendan Scully, MD

Assistant Professor
Rutgers- Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States

Disclosure information not submitted.
NM

Nell Maloney Patel, MD

Vice Chair of Education
Rutgers Robert Wood Johnson Medical School
Westfield, New Jersey, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Daniel L. Feingold, MD, FASCRS, FACS

Professor of Surgery
Rutgers Robert Wood Johnson Medical School
Warren, New Jersey, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Kristen Donohue, MD, FACS, FASCRS

Assistant Professor of Surgery
Rutgers Robert Wood Johnson Medical School
Atlantic Highlands, NJ, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Ashley Toussaint, DO: This individual has no financial relationships with ineligible companies.

Andrew Hu, MD: This individual has no financial relationships with ineligible companies.

Nell Maloney Patel, MD: This individual has no relevant relationships with ineligible companies.

Daniel L. Feingold, MD, FASCRS, FACS: This individual has no financial relationships with ineligible companies.

Kristen Donohue, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Standard therapy for locally advanced colon cancer typically involves upfront surgery followed by adjuvant chemotherapy. However, recent studies demonstrate advantages to neoadjuvant therapy including improved complete resection rates and decreased surgical morbidities. Video depictions of minimally invasive resections of colonic masses following neoadjuvant therapy are lacking. We present a case of robotic right colectomy following neoadjuvant chemoimmunotherapy for locally invasive hepatic flexure colon cancer with concerns for duodenal invasion.

Methods/Interventions: This patient had a past medical history significant for hepatitis B and presented with 3 months of right sided abdominal pain and change in stool caliber. Colonoscopy revealed a 6cm partially obstructing tumor in the proximal transverse colon. Pathology was invasive adenocarcinoma, moderately differentiated, MSI-intact on tumor biopsy, however was MSI-high, TMB-high on Guardant and Caris testing. Preoperative imaging demonstrated intimate involvement between the colonic mass and duodenum, with a potential loss of plane that could necessitate a whipple en bloc resection.

Results/Outcomes: The patient received five months of FOLFOX-Nivolumab preoperatively (10 cycles), with chemotherapy held two months prior to surgery. Imaging post neoadjuvant therapy revealed a significant response and decrease in tumor size. Intraoperatively, the duodenum was free inferiorly; however, superiorly the duodenum (D1-D2) was adhered to the transverse colon mesentery. Significant fibrosis was also encountered during mobilization of the colon off the retroperitoneum near the duodenum and head of pancreas. Post-operatively, the patient recovered appropriately and had no complications. Subsequently the patient was discharged home on post-operative day 5. Post-operative pathology was significant for a pathologic complete response (ypT0N0).

Conclusion/Discussion: Neoadjuvant therapy in locally advanced colon cancer results in a pathologic complete response and proves effective in a minimally invasive approach to tumor resection. This case suggests neoadjuvant therapy may decrease incomplete resection rates and decrease surgical morbidity through minimally invasive resection of invasive colon cancer.