Laparoscopy is becoming gold standard for Colorectal cancer surgery. We at our center resect most colorectal cancers via laparoscopic route. Recently we did an interesting case.

75 year old gentleman came to us with cancer of sigmoid colon extending into upper rectum. Patient also had a large polypoidal tumor in the mid rectum that was benign in nature. This tumor was large in size to just attempt a polypectomy. Also it could be malignant in nature on final histopathology. Hence it was decided to be included in the surgery. One difficulty was that endoscope was unable to go past the cancer bearing colon as it was nearly obstructed, hence could not be used to see any other tumors higher up. To solve this problem and to check any tumor spread, a PET CT was done. It did not reveal any spread or more tumors in the proximal colon.

Patient was subjected to a laparoscopic colorectal resection. An endoscopy performed during the surgery to confirm that lower polypoidal lesion was included in the resection. Based on final histopathology patient is started on chemotherapy. He is advised to undergo another colonoscopy to confirm status of proximal colon.

Colonic cancer can occur simultaneously at multiple sites in the colon. Hence it is vital to do a complete colonoscopy prior to surgery whenever possible. If that is not possible due to obstruction, a PET CT is useful. When multiple cancers are present, they are resected at the same time. Often these patients require a total colectomy.