Case Report: Neoadjuvant FOLFOXIRI followed by laparoscopic en bloc resection and psoas hitch reconstruction for locally advanced colorectal cancer with suspected ureteral invasion: a three-case series.

Radical resection is essential for achieving R0 resection and improving prognosis in patients with locally advanced colorectal cancer (CRC) involving adjacent organs. When combined ureteral resection is required, urinary tract reconstruction is critical, as it influences both the risk of complications and postoperative quality of life. Here, we report three cases of locally advanced CRC with suspected ureteral invasion, treated with neoadjuvant chemotherapy (NAC) followed by laparoscopic tumor resection and ureteral reconstruction using the psoas hitch technique, which avoids the use of intestinal segments. Three patients with locally advanced CRC and suspected ureteral involvement received six cycles of FOLFOXIRI-based neoadjuvant chemotherapy (with panitumumab added in one patient). After significant tumor shrinkage, laparoscopic radical resection, including combined ureteral resection, was performed. Ureteroneocystostomy was carried out under direct vision through a lower transverse (Pfannenstiel) incision. Operative times ranged from 505 to 727 min, with no major complications. Postoperative histopathology revealed ypT3N0M0, ypT3N1aM0, and ypT4bN1bM0, respectively, with no pathological evidence of ureteral invasion. All patients received adjuvant chemotherapy and remain recurrence-free to date. Renal function was preserved postoperatively in all cases. We describe three cases in which neoadjuvant chemotherapy effectively shrank locally advanced CRC, yet combined ureteral resection was still necessary to ensure a secure R0 resection. Our approach enabled curative resection while preserving renal function and allowing for the timely initiation of adjuvant chemotherapy. When appropriate cases are selected, the psoas hitch technique can be a feasible and safe method for ureteral reconstruction.