Recently, Ms. Thanh experienced persistent dull abdominal pain. Upon examination at Tam Anh General Hospital, Ho Chi Minh City, she was diagnosed with recurrent colon cancer at the previous site. A colonoscopy revealed an ulcerated tumor in the lower rectum, approximately 6 cm from the anal verge. A biopsy confirmed moderately differentiated adenocarcinoma. MRI scans showed abnormal thickening of the rectal wall, with the lesion penetrating the rectal muscle layer and spreading into the surrounding fatty tissue, along with several regional lymph nodes suspected of metastasis.

Doctor Nguyen Quoc Thai, Head of Gastrointestinal Surgery at the Center for Endoscopy and Endoscopic Gastrointestinal Surgery, explained that after chemo-radiotherapy, many cancer cells can persist at a microscopic level within the rectal wall or nearby lymph nodes. Standard diagnostic methods often fail to detect these, leading to a risk of local recurrence.

Following a consultation, doctors determined the recurrent tumor had invaded beyond the rectal wall. The patient was prescribed pre-operative chemo-radiotherapy to shrink the tumor, reduce its invasiveness, and increase the chances of radical surgery.

After 12 cycles of treatment, the tumor responded well, making the patient eligible for surgery.

A robotic arm performing tumor resection surgery on Ms. Thanh. Photo: Tam Anh General Hospital.

Doctor Thai noted that Ms. Thanh had previously undergone a hysterectomy and partial oophorectomy, followed by chemo-radiotherapy. This resulted in significant fibrous tissue, adhesions, and altered anatomy in the pelvic cavity. The surgical team opted for Da Vinci Xi robotic surgery to enhance precision.

The rectum is deep within the narrow pelvic cavity, and distinguishing anatomical layers becomes even more challenging after chemo-radiotherapy. The robot provides high-resolution magnified images and flexible arms, aiding in dissection around the tumor, minimizing damage to healthy tissue, and reducing bleeding.

Doctors resected the entire rectal segment containing the tumor, performed regional lymph node dissection, and reconstructed the digestive tract. The patient received a temporary protective ileostomy to reduce pressure on the anastomosis during the initial recovery phase.

Doctor Thai operating the surgical robot, performing thorough lymph node dissection on Ms. Thanh. Photo: Hospital provided.

Post-surgery, Ms. Thanh was able to sit up and walk from the first day, started a liquid diet, and was discharged after 5 days. Histopathology results indicated stage three cancer. However, due to multiple high-risk factors for recurrence, the patient requires continued adjuvant therapy.

Rectal cancer is common and carries a high risk of recurrence. The overall recurrence rate for rectal cancer ranges from 10% to 30%, depending on the disease stage, tumor biology, and treatment effectiveness. Recurrence can occur at the original rectal site, within the pelvis, or metastasize to other organs such as the liver, lungs, peritoneum, and bones, according to Doctor Thai.

To reduce the risk of recurrence, patients must fully adhere to prescribed treatment steps, including pre-operative chemo-radiotherapy when necessary, radical surgery, and regular follow-up appointments as advised. Early detection of recurrence improves the chances of successful treatment and prolongs patient survival.

By Quyen Phan

*Patient's name has been changed.