With careful preoperative preparation and inventive surgical and anesthesia methods, we performed splenectomy and open sigmoidectomy with lymph node dissection by HALS at one time for advanced sigmoid colon cancer complicated by severe COPD and ITP, and here report the satisfactory results obtained. The patient was a 72-year-old woman. She had consulted a nearby doctor with chief complaint of melena and was referred to our hospital when sigmoid colon cancer was diagnosed by lower gastrointestinal endoscopy. She also had COPD due to a long history of smoking and a high degree of obstructive impairment was observed in respiratory function test. From her first outpatient visit she started cessation of smoking, respiratory function training and use of an inhaled bronchodilator.
She also had ITP, with a low platelet count of 10000/μL on the first examination at the department of surgery, and gamma-globulin massive dose therapy was conducted immediately before surgery. The operation was an open sigmoidectomy plus D2 dissection performed with splenectomy by HALS and elongation of the HALS wound, from the perspective of minimally invasive surgery and avoiding prolonged pneumoperitoneum. Anesthesia was general without the use of muscle relaxant, using epidural anesthesia combined with continuous probofol infusion for spontaneous ventilation. The post operative course was satisfactory and the patient was discharged 11 days after surgery.