Robotic Subtotal Colectomy with en-bloc Resection of the Left Chest wall for Locally Advanced Colonic Cancer: A Case Report and Literature Review

Document Type : Case Report


1 Colorectal Department, Queen Alexandra Hospital, UK

2 Radiology Department, Queen Alexandra Hospital, UK

3 Colorectal Department, Queen Alexandra Hospital, UK Anglia Ruskin University, UK


Locally advanced colonic cancers requiring multivisceral en-bloc resections are typically undertaken in an open or laparoscopic approach. Here, we report a case of a complex robotic subtotal colectomy with en-bloc resection of the chest wall and left 10th to 12th ribs for management of a locally advanced descending colon cancer and peritumoral abscess at our institution in June 2020. The procedure was augmented with intraoperative ultrasound scan-guided marking to delineate tumoural extent. Histologically, negative excision margins (R0) were achieved.
We also undertook a brief review of relevant literature. There are very few publications on the multivisceral resections for advanced colonic cancer; this is the second reported case of robotic en-bloc colonic resection in English literature. A similar case report published in 2019 enforced the value of multidisciplinary team collaboration and the benefits of robotic over laparoscopic surgery in en-bloc resections. Considering improved short-term outcomes and comparable oncological safety granted by laparoscopic surgery, minimally-invasive surgery has a clear role in the surgical management of locally-advanced colorectal cancers.
Key words: en-bloc resection, multivisceral resection, colonic cancer, robotic surgery, subtotal colectomy, peritumoural abscess


Cutsem EV, Cervantes A, Nordlinger B, Arnold D. Metastatic colorectal cancer: ESMO clinical guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014; 21(3):iii1‒iii9.
2. Takahashi R, Hasegawa S, Hirai K, Hisamori S, Hida K, Kawada K, Sakai Y. Safety and feasibility of laparoscopic multivisceral resection for surgical T4b colon cancers: Retrospective analyses. Asian J Endosc Surg. 2017;10:154‒161.
3. Stefan S, Siddiqi N, Rutgers M, Naqvi S, Khan J. Robotic multivisceral resection for locally-advanced rectal cancer invading other viscera. Eur J Surg Oncol. 2019;2197.
4. Chen TC, Liang JT. Video vignette ‒ Robotic radical surgery in the multidisciplinary approach for the treatment of locally advanced T4 rectosigmoid colon cancer. Dis Colon Rectum. 2019;62:121‒122.
5. Nagasue Y, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, et al. Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes. J Gastrointest Surg. 2013;17:1299‒1305.
6. Yang X, Zhong ME, Xiao Y, Zhang GN, Xu L, Lu J, et al. Laparoscopic vs open resection of pT4 colon cancer: a propensity score analysis of 94 patients. Col Dis. 2018;20:O316‒O325.
7. Mukai T, Nagasaki T, Akiyoshi T, Fukunaga Y, Yamaguchi T, Konishi T, et al. Laparoscopic multivisceral resection for locally advanced colon cancer: a single center analysis of short and long term outcomes. Surgery Today. 2020.
8. Seymour M, Morton D. FoxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer.  Journal of Clinical Oncology 2019;37(15):3504-3504.