Total colectomy: indications and outcomes in colorectal pathology

Abstract

Colorectal cancer remains one of the leading causes of cancer-related morbidity and mortality worldwide. The presence of synchronous tumors poses a significant challenge in surgical management, often requiring more extensive resections to achieve adequate oncological control. Total colectomy is considered a viable option in selected patients with multifocal or extensive colonic disease, as it allows complete removal of the affected organ and reduces the risk of metachronous lesions. We present the case of a 62-year-old female patient with no significant family history, who presented with weight loss, anemia, and changes in bowel habits. Colonoscopy revealed two synchronous lesions located in the ascending colon and sigmoid colon. Histopathological analysis confirmed moderately differentiated mucinous adenocarcinoma in both sites. Imaging studies showed no evidence of distant metastasis. The patient underwent total colectomy with ileorectal anastomosis. The postoperative course was uneventful, with adequate recovery and no evidence of complications. Final pathology reported tumors staged as T3N0M0 and T2N0M0, with negative surgical margins and no lymph node involvement. At follow-up, the patient demonstrated good clinical evolution and satisfactory functional outcomes. This case highlights the importance of recognizing synchronous colorectal cancer and selecting an appropriate surgical strategy. Total colectomy provides an effective oncological approach in such cases, offering complete disease control and reducing the likelihood of future colonic malignancies.