PMC9803779_01
Colonoscopic findings.. a) Circumferential type 3 tumor was found in the left transverse colon in Patient 1.. b) Circumferential type 2 tumor was found in the rectosigmoid colon in Patient 2.. c) Circumferential type 2 tumor was found in the sigmoid colon in Patient 3.
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Colonoscopy showed a circumferential type 3 tumor in the left side of the transverse colon in Patient 1, a circumferential type 2 tumor in the rectosigmoid colon in Patient 2 and a circumferential type 2 tumor in the sigmoid colon in Patient 3, and the scope could not pass through due to strong stenosis in Patients 1 and 3 (Fig. 1).
CT scan findings.. a) Circumferential wall thickening with contrast enhancement was observed in the left transverse colon in Patient 1.. b) IMV tumor thrombosis was suspected due to poor contrast and dilation of the IMV in Patient 1.. c) Circumferential wall thickening with contrast enhancement was observed in the rectosigmoid colon in Patient 2.. d) A mass lesion with irregular ring enhancement was found in liver (S6) in Patient 2.. e) IMV tumor thrombosis was suspected due to poor contrast and dilation of the IMV in Patient 2.. f) Circumferential wall thickening with contrast enhancement was observed in the sigmoid colon in Patient 3.. g) IMV tumor thrombosis was suspected due to poor contrast and dilation of the IMV in Patient 3.
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An irregular ring-enhancing lesion in segment (S) 6 of the liver was found in Patient 2 (Fig. 2).
Intraoperative findings.. a) We isolated the IMV at the level of the inferior margin of pancreas where the vein wall was soft and considered free from tumor invasion in Patient 1.. b) We isolated the IMV at as central a point as possible to the extent that it is safely operable where the vein wall was soft and considered free from tumor invasion in Patient 2.. c) We isolated the IMV at as central a point as possible to the extent that it was safely operable where the vein wall was soft and considered free from tumor invasion in Patient 3.
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We then isolated the IMV at the level of the inferior margin of the pancreas (Fig. 3a). We identified a location where the IMV could be isolated, as in Patient 1, and isolated the IMV at as central a point as possible to the extent that it is safely operable (Fig. 3b). We isolated the IMV as in Patient 2 (Fig. 3c).
a) Macroscopic features of the resected specimen in Patient 1. Induration was palpable in the IMV, and tumor thrombosis was suspected.. b) Pathological findings of the resected specimen in Patient 1. Tumor cells (red arrowhead) were found in the IMV stump (blue arrowhead), and the presence of residual cancer cells at the surgical margin was suspected.. c) Macroscopic features of the resected specimen in Patient 2.. d) Macroscopic features of the resected specimen in Patient 3. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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While the circumferential resection margin at the primary lesion was negative, tumor cells were found at the cut-end of the IMV, leading to the diagnosis of R1 resection in all cases (Fig. 4).