Cecal cancer with essential thrombocythemia treated by laparoscopic ileocecal resection: a case report

Abstract

Background Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by thrombocytosis and a propensity for both thrombotic and hemorrhagic events. ET rarely occurs simultaneously with colorectal cancer. Here, we report a case of colorectal cancer in an ET patient treated using laparoscopic ileocecal resection. Case presentation A 40-year-old woman was admitted to our hospital after presenting with liver dysfunction. She had been previously diagnosed with ET; aspirin and anagrelide had been prescribed. Subsequent examination at our hospital revealed cecal cancer. Distant metastasis was absent; laparoscopic ileocecal resection was performed. Anagrelide was discontinued only on the surgery day. She was discharged on the seventh postoperative day without thrombosis or hemorrhage. However, when capecitabine and oxaliplatin were administered as adjuvant chemotherapy with continued anagrelide administration, she experienced hepatic dysfunction and thrombocytopenia; thus, anagrelide was discontinued. Five days later, her platelet count recovered. Subsequently, anagrelide and aspirin administration was resumed, without any adjuvant chemotherapy. Her liver function normalized gradually in 4 months. One-year post operation, she is well without tumor recurrence or new metastasis. Conclusions To our knowledge, this is the first report of laparoscopic colectomy performed on an ET patient receiving anagrelide. Our report shows that complications such as bleeding or thrombosis can be avoided by anagrelide administration. Contrastingly, thrombocytopenia due to anagrelide intake should be considered when chemotherapy that could cause bone marrow suppression is administered.

Postoperative bleeding in essential thrombocytosis patients with colorectal cancer: Case report and literature review

“…Hepatic veins Angioplasty 2. transjugular intrahepatic porta caval shunt (TIPS) Zhu [15] 2017 61/F Laparoscopic sigmoid colectomy Yes None Preoperative plateletpheresis 915 None Anastomotic bleeding Dilute noradrenaline as a retention enema, and 0.5 U of hemocoagulase was injected. Hiyoshi [16] 2019 40/F Laparoscopic ileocecal resection NR None aspirin (100 mg/day) and anagrelide (2.5 mg/day) 624 Elastic stocking and intermittent pneumatic compression Asymptomatic thrombocytopenia None Hosada [17] 2021 68/M Esplenectomy Yes Acute hearth failure induced by anagrelide aspirin (100 mg/day) 854 None Bleeding from the drain insertion site and wound, epistaxis, and hemorrhoidal bleeding Reoperation for hemostasis and intaabdominal hematoma evacuation Kim (current case) 2021 41/F Laparoscopic low anterior resection with lymph node dissection Yes 3 miscarriages (2 abortions, 1 Dilatation and curetagge) aspirin (100 mg/day) and anagrelide (2.5 mg/day) 920 Elastic stocking and intermittent pneumatic compression Abdominal bleeding Angiography and vessel embolization under US and fluoroscopy guidance. …”

“…Only seven abdominal surgery cases with an associated ET diagnosis have been reported [12] , [13] , [14] , [15] , [16] , [17] , 4 of them presenting bleeding as a postoperative complication. Currently, there are no perioperative indications for emergency plateletpheresis, thromboprophylaxis, or suspension of previous treatments.…”

General anesthesia with nerve blocks for a patient with femoral fracture and essential thrombocythemia: a case report

“…Moreover, most past studies on the use of anesthesia for ET are case reports. For example, Hiyoshi et al reported the treatment of an ET patient with laparoscopic ileocecal resection under general anesthesia, 14 while another case report documented an 81-year-old woman with ET who underwent laparoscopic right hemicolectomy. 15 General anesthesia or intravertebral anesthesia are typically available for femoral fractures under standard conditions, but intervertebral anesthesia should only be used if platelet counts and aggregation tests are within normal ranges.…”

“…Moreover, most past studies on the use of anesthesia for ET are case reports. For example, Hiyoshi et al reported the treatment of an ET patient with laparoscopic ileocecal resection under general anesthesia, 14 while another case report documented an 81-year-old woman with ET who underwent laparoscopic right hemicolectomy. 15…”

Unpredictable post-laparoscopic bleeding in essential thrombocytosis: a call for additional safety measures

“…Others performed laparoscopic surgery while the patients were receiving anagrelide. 10 In conclusion, patients with ET should consent to rare but possible post-laparoscopic bleeding. Surgeons should offer these treatments to ensure hemostasis.…”