Total ureteral replacement with a small intestinal graft as a reconstructive stage of combined treatment for recurrent colorectal cancer: case report.

INTRODUCTION

We present a clinical case highlighting total ureteral replacement with a small intestinal graft as a key reconstructive component in the surgical management of recurrent colorectal cancer.

CASE DESCRIPTION: A 48-year-old female patient previously underwent low anterior rectal resection with D2 lymph node dissection (pT2N0M0, 2018). Four years later, she presented with clinical signs of obstruction in the middle third of the left ureter. Imaging revealed a mass involving the ureteral wall and left psoas muscle, alongside left adnexal abnormalities. Surgical treatment was staged and included en bloc resection of the recurrent mass with removal of the left ureter, adnexectomy, and segmental colectomy. In the remission phase, ureteral reconstruction was performed using a small intestinal graft, followed by transverse colon mobilization and the creation of a stapled transverse-rectal anastomosis.

DISCUSSION: This case illustrates how timely, organ-preserving reconstruction - integrated into comprehensive oncological surgery - can improve both survival and quality of life in patients with locally advanced recurrent rectal cancer.