THE LAST I MAGE

Resection of recurrent rectal cancer with encasement of external

iliac vessels
S. Maslekar

P. M. Sagar

A. I. D. Mavor

D. Harji

C. Bruce
Received: 10 July 2011 / Accepted: 23 October 2011
Springer-Verlag 2011
Introduction
Surgical intervention after the recurrence of rectal cancer
increases survival and offers good control of symptoms [1].
Such recurrences can involve the central soft tissues,
invade into the sacrum or involve the pelvic side-wall and
associated vascular structures. This latter group is partic-
ularly challenging [2]. We present such a surgical case to
highlight operative strategies (Figs. 1, 2, 3, 4, 5, 6, 7).
S. Maslekar P. M. Sagar (&) D. Harji C. Bruce
The John Goligher Department of Colorectal Surgery,
The General Inrmary at Leeds, Leeds LS1 3EX, UK
e-mail: petersagar@aol.com
A. I. D. Mavor
Department of Vascular Surgery, The General Inrmary
at Leeds, Leeds LS1 3EX, UK
Fig. 1 MR image (T1 weighted with gadolinium enhancement) that
shows tumour recurrence with encasement of the left external iliac
artery and vein (arrow)
Fig. 2 Puckering of peritoneum over the mass
Fig. 3 Vascular sloops around external iliac artery (green) and vein
(yellow)
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Tech Coloproctol
DOI 10.1007/s10151-011-0787-0
Conict of interest The authors declare that no conict of interest
exists.
References
1. Hahnloser D, Nelson H, Gunderson LL et al (2003) Curative
potential of multimodality therapy for locally recurrent rectal
cancer. Ann Surg 237:502508
2. Heriot AG, Byrne CM, Lee P et al (2008) Extended radical
resection: the choice for locally recurrent rectal cancer. Dis Colon
Rectum 51:284291
Fig. 5 The external iliac artery has been divided between vascular
clamps and the mass removed en bloc. Tumour bed shown with black
arrow
Fig. 6 Vein graft to restore arterial ow. Venous drainage was left to
travel via collaterals
Fig. 7 The resected mass (tumour with vessels). Histopathology
conrmed an R0 resection
Fig. 4 The external iliac vein has been ligated and divided (prolene
sutures (blue) (white arrow)). The dissection continues behind the
mass (black arrow)
Tech Coloproctol
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