[A Case of Stage Ⅳ Rectal Cancer with Four Pneumonectomies after Resection of the Primary Tumor, Surviving without Recurrence for 14 Years after the Final Pneumonectomy].

A 77-year-old male patient with cT4N1aM1(PUL1), cStage Ⅳ rectal cancer underwent low anterior resection in Y20XX with a plan to perform pneumonectomy after resection of the primary tumor. The pathological diagnosis was pT3N0M1 (PUL1), pStage Ⅳ mucinous adenocarcinoma ly1, v1, pPM0, pDM0. A thoracoscopic left lung S4 segmentectomy was performed Y+2 months later and a thoracoscopic right upper lung partial lobectomy was performed Y+6 months later. However, a small nodule appeared in the lower lobe of the right lung on postoperative follow-up CT and continued to grow, so a partial resection of the lower lobe of the right lung was performed Y+12 months later. However, a 6 mm-sized mass appeared in the left upper lobe of the lung on postoperative follow-up CT, and it continued to grow, so partial resection of the left upper lobe was performed Y+20 months later. Both pathological diagnoses were pulmonary metastasis of rectal cancer. Since the patient had had 3 metastatic recurrences at this point, postoperative adjuvant chemotherapy(S-1)was administered from Y+22 months. Since then, the patient has been alive without metastasis or recurrence, and is still recurrence-free 14 years after the last pneumonectomy.