Our Summary

This research paper is about a successful case of performing surgery for colon cancer in a patient who also suffered from a rare disease called Mixed Connective Tissue Disease (MCTD) and a serious lung condition called Pulmonary Arterial Hypertension (PAH).

The patient, a 52-year-old woman, had a type of colon cancer called sigmoid cancer. People with MCTD have higher chances of developing PAH, which can cause serious heart and lung problems during surgery. In the worst cases, it can even lead to death. To avoid this, the doctors carefully planned the surgery and treatment process.

Before the surgery, the doctors switched the patient’s medication from an oral drug to a drug called epoprostenol, which was given directly into the bloodstream. This helped to control the high blood pressure in the lungs caused by PAH.

During the surgery, instead of using laparoscopy (a less invasive procedure using a small camera), the doctors chose to perform open surgery. They also performed a specific operation called Hartmann’s operation and tied off certain blood vessels to prevent severe swelling after the surgery.

Following the operation, the patient did not experience any serious complications and was able to leave the hospital 17 days later. The doctors concluded that their approach of controlling the lung blood pressure, performing open surgery, and managing the blood vessels could be a useful strategy to prevent complications during surgery for patients with similar conditions.

FAQs

  1. What is Mixed Connective Tissue Disease (MCTD) and how does it relate to colon cancer surgery?
  2. What precautions did the doctors take to manage the patient’s Pulmonary Arterial Hypertension (PAH) during the surgery?
  3. Why did the doctors choose to perform open surgery instead of a less invasive laparoscopy for this patient?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sigmoidectomy is to carefully follow all pre-operative instructions provided by your healthcare team, including any changes to medications. It is important to communicate any underlying health conditions, such as MCTD and PAH, to your healthcare provider so they can tailor your treatment plan to reduce the risk of complications during and after surgery. Following post-operative care instructions and attending follow-up appointments is also vital for a successful recovery.

Suitable For

Patients who are typically recommended sigmoidectomy are those with sigmoid cancer, particularly if it is in a more advanced stage. Additionally, patients with underlying conditions such as Mixed Connective Tissue Disease (MCTD) and Pulmonary Arterial Hypertension (PAH) may also benefit from sigmoidectomy, although careful planning and management of these conditions are essential to ensure a successful outcome. Patients with MCTD who have a higher risk of developing PAH may require special considerations and adjustments to their treatment plan to minimize the risk of complications during surgery.

Timeline

Before sigmoidectomy:

  • Patient is diagnosed with sigmoid cancer and also has Mixed Connective Tissue Disease (MCTD) and Pulmonary Arterial Hypertension (PAH)
  • Doctors switch patient’s medication to control high blood pressure in the lungs
  • Surgery is carefully planned to avoid complications related to PAH

After sigmoidectomy:

  • Open surgery is performed instead of laparoscopy
  • Specific operation called Hartmann’s operation is performed
  • Blood vessels are tied off to prevent severe swelling
  • Patient does not experience serious complications after the surgery
  • Patient is able to leave the hospital 17 days later

Doctors conclude that their approach of controlling lung blood pressure, performing open surgery, and managing blood vessels could be useful in preventing complications for similar patients.

What to Ask Your Doctor

  1. What is sigmoidectomy and why is it necessary in my case?

  2. How will my rare disease, Mixed Connective Tissue Disease (MCTD), and my lung condition, Pulmonary Arterial Hypertension (PAH), affect the surgery and my recovery?

  3. What specific precautions will be taken to ensure my safety during and after the surgery, given my unique medical conditions?

  4. What alternatives to laparoscopy are available for this surgery, and why did you choose to perform open surgery in my case?

  5. How will my medication be managed before, during, and after the surgery to prevent complications related to my PAH?

  6. What is Hartmann’s operation and why was it chosen for my surgery?

  7. What potential complications should I be aware of following the surgery, and how will they be managed?

  8. How long is the expected recovery time after sigmoidectomy, and what steps can I take to aid in my recovery process?

  9. Are there any long-term effects or considerations I should be aware of following this surgery, particularly in relation to my MCTD and PAH?

  10. Are there any specific lifestyle changes or follow-up appointments I should adhere to post-surgery to ensure the best possible outcome?

Reference

Authors: Takagi Y, Koyama M, Miyagawa Y, Kitazawa M, Kimura K, Soejima Y. Journal: Int J Surg Case Rep. 2021 Jun;83:105906. doi: 10.1016/j.ijscr.2021.105906. Epub 2021 Apr 27. PMID: 34023548