A 71-year-old man was admitted by systemically massive edema and advanced rectal cancer. His hemoglobin or serum albumin level was 7.5 g/dL or 1.2 g/dL. Proteinuria ranged from 1.8 to 3.8 g/day. Massive effusion in chest and abdomen was obvious with low oxygenation and unstable hemodynamic state. Renal biopsy showed membranous nephropathy. Abdomino-perineal resection of the rectum was performed. Specimens showed poorly differentiated adenocarcinoma. The classification was type 1, 90 × 85 mm, pAI (seminal grand), pN3, sH0, sP0, cM0: fStage IIIb. The nephrotic syndrome was evidently improved with no urinary excretion of albumin at forty-postoperative day. The perioperative management allowed a surgical resection to be undertaken that led the clinical curability in rectal cancer as well as nephrotic syndrome.

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