case_images: PMC10772238_01
case_images: (a) In 3D-CT, the primary site of rectal cancer is indicated by a green tumor (circle), and lymph node metastases are indicated by a red node (arrow).. (b) Pre-chemotherapy colonoscopy shows a semi-peripheral type 2 lesion in the rectum (left), and post-chemotherapy colonoscopy shows shrinkage from pre-chemotherapy (right).. (c) Preoperative stoma site markings.. (d) Subcutaneous fat thickness at the umbilical level is 7 cm. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: PMC10772238_01_gr1.jpg
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case_images: Further examination revealed lower rectal cancer with lymph node metastases, cT3N2aM0, cStage IIIB (Union for International Cancer Control (UICC) 8th edition) (Fig. 1a, b left). Colonoscopy performed after chemotherapy revealed shrinkage of the primary tumor, and the endoscopic response was considered to be partial (Fig. 1b right). Stoma site marking was performed (Fig. 1c). Additionally, preoperative computed tomography (CT) revealed 7-cm subcutaneous fat at the umbilical level (Fig. 1d).
case_images: (a) CT image showing the primary descending colon cancer (left circle), a nodule suspected of peritoneal dissemination (left arrow) and liver metastases (right arrow). The thickness of the subcutaneous fat could not be measured because the thickness of the abdominal wall exceeded the CT imaging range.. (b) Preoperative simulation photograph. The abdominal wall was fixed with a side plate owing to the large amount of subcutaneous fat that caused it to sag.. (c) Epidermal closure was not performed (left) and NPWT was initiated (right).
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case_images: PMC10772238_01_gr2.jpg
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case_images: IVC (UICC 8th edition) with colonic penetration and abscess formation (Fig. 2a). In this patient, distant metastases were present, curative resection was not possible, and early initiation of systemic chemotherapy was necessary. On the day before the surgery, we performed positional simulation in the operating room and confirmed its safety (Fig. 2b). SSI was deemed inevitable, skin closure was not performed (Fig. 2c left) for early initiation of negative pressure wound therapy (NPWT) postoperatively (Fig. 2c right).