Laparoscopic surgery for colorectal cancers complicated by Leriche syndrome: A report of three cases

Abstract

Leriche syndrome is a disease of aortoiliac occlusion, which causes diminished femoral pulses, impotence and claudication. As blood flow to the rectum is also decreased in Leriche syndrome, reconstruction with anastomosis may be complicated by ischemia when performing rectal cancer surgery. The inferior epigastric arteries often provide collateral circulation to the lower limbs in patients with Leriche syndrome, therefore, attention should be paid not to injure them during trocar insertion when performing laparoscopic surgeries. The present study is a report on three cases of patients with colorectal cancer who were successfully treated with laparoscopic surgeries. The first case was of a 71-year-old man with rectal cancer. A preoperative computed tomography (CT) scan revealed occlusion of the aorta below the origin of the inferior mesenteric artery. The blood flow to the lower limbs was supplied through collateral arteries, including the inferior epigastric arteries and the deep circumflex iliac arteries. A laparoscopic Hartmann's operation was performed successfully following marking of the inferior epigastric arteries using ultrasonography to avoid damaging them during trocar insertion. The second case involved a 70-year-old man with three colorectal cancers of the transverse and sigmoid colon and rectum. A CT scan revealed occlusion of the aorta below the origin of the renal arteries. Laparoscopic assisted low anterior resection and left hemicolectomy with colostomy were performed. The final patient was a 61-year-old man with rectal cancer. As the right internal iliac artery was patent, the patient underwent laparoscopic assisted low anterior resection. All the patients were discharged from the hospital without complications. It is important to visualize the image the blood flow via CT angiography and to mark collateral arteries using ultrasonography preoperatively in patients with Leriche syndrome for whom laparoscopic surgery was planned for to treat colorectal cancer.

A rare case of sigmoid colon cancer in which the lower limbs received collateral blood flow from the inferior mesenteric artery owing to peripheral artery disease

“…Some case reports of rectal resection with PAD have advocated that anastomosis should be avoided because of its potentially high risk of leakage due to poor blood microcirculation [ 10 ]. On the other hand, ICG-FI during surgical procedures is a well-recognized method for evaluating blood perfusion of the remaining gut and may contribute to reduction of the anastomotic leak [ 11 ].…”

Colonic ischemia developed after laparoscopic colectomy for rectosigmoid cancer with focal infrarenal aortic stenosis

“…There have been only a few reports on surgery for colorectal cancer with aortic occlusive disease . Murano et al .…”

“…Murano et al . described three cases of colorectal cancer complicated by Leriche syndrome that were successfully treated with laparoscopic surgery . They took care not to injure the inferior epigastric artery during trocar insertion because the artery supplied the blood flow to the lower limb as a collateral pathway.…”