A 77-year-old woman presented with weight loss and pain in the right lower abdomen that started 1 month prior to admission. Her past medical history was significant for hypertension requiring medication. Her family history did not include any colorectal cancer. Laboratory data showed anemia and an elevated carcinoembryonic antigen (CEA) level of 5.7 ng/mL. Colonoscopy showed an obstructive, advanced tumor in the cecum, and biopsy revealed adenocarcinoma. Abdominal computed tomography (CT) showed an irregular, contrast-enhanced wall thickening in the cecum with enlarged pericolic lymph nodes. She was diagnosed with locally advanced cecal cancer. Considering the progressive pain and small bowel dilation caused by the obstructive large tumor, we performed ileocecal resection with open laparotomy. The pathological diagnosis was tubular and mucinous adenocarcinoma with T3N2aM0 (stage IIIB, UICC TNM classification 8th edition []). Postoperative course was uneventful, and the CEA level was subsequently normalized. She was started on capecitabine plus oxaliplatin (CAPOX: oral capecitabine 2000 mg/m2 daily on days 1–14 plus intravenous oxaliplatin 130 mg/m2 on day 1 of a 3-week cycle) therapy as adjuvant chemotherapy from 6 weeks after the surgery. Three months after the surgery, she noticed abdominal bulging at the midline incision site. She was diagnosed with incisional hernia on physical examination. She had tolerated 8 courses of CAPOX therapy. After the completion of adjuvant chemotherapy, surveillance CT was performed and showed no cancer recurrence (10 months after the surgery). Her abdominal discomfort persisted because of incisional hernia, and she claimed that her daily quality of life (QOL) had been deteriorated. She wished to undergo surgical intervention for incisional hernia. Therefore, we planned of laparoscopic incisional hernia repair 11 months after the initial surgery. Laparoscopic repair was performed using the intraperitoneal onlay mesh technique. Exploratory laparoscopy showed no liver or peritoneal metastasis. The hernia orifice was 5.2 cm × 5.0 cm in size with minimal adhesions. The defect was closed using absorbable barbed suture, and a multifilament polyester mesh with a bioabsorbable collagen film was placed to cover the defect. The mesh was trimmed to obtain a 5-cm overlap for the defect. The mesh was fixed with prefixed threads and absorbable tacks by the double-crown technique (). Five months after incisional hernia repair (16 months after the initial surgery), surveillance CT showed abdominal wall metastases in the midline and multiple liver and peritoneal metastases (a–e). The CEA level increased to 9.9 ng/mL. These metastatic lesions were obviously unresectable, indicating systemic chemotherapy. Because the previously resected colon cancer specimen showed RAS mutation, we selected FOLFIRI plus bevacizumab regimen consisted of bevacizumab (5 mg/kg), irinotecan (150 mg/m2), bolus FU (400 mg/m2) and leucovorin (400 mg/m2), followed by 46-h FU infusions (2400 mg/m2). Two days after the first therapeutic infusion, she had nausea and vomiting. Abdominal CT showed small bowel obstruction. Conservative treatment was initiated with fasting and intestinal intubation, but her obstructive symptoms had repeatedly occurred at short intervals. Thereafter, we decided to perform palliative surgery with intestinal bypass. The surgery was commenced with exploratory laparoscopy, which revealed local recurrence around the anastomosis and that the mesh used for incisional hernia repair was completely covered with multiple nodules of peritoneal metastasis (). Then, we performed laparotomy in the left upper quadrant and constructed intestinal bypass between the jejunum and transverse colon. Two months after the bypass surgery, she resumed on FOLFIRI plus bevacizumab regimen (the same as the aforementioned protocol). After 4 courses, CT showed significant progression of all recurrent lesions. At this point, she did not wish to undergo further chemotherapy and decided to receive the best supportive care. She was transferred to a nursing facility and died 2 years after the initial surgery.