内容紹介
Summary
We report a case of anastomotic recurrence following laparoscopic sigmoidectomy with hand-sewn anastomosis, which was attributable to the implantation of exfoliated cancer cells. A 78-year-old man diagnosed with early colon cancer underwent endoscopic submucosal dissection(ESD); however, ESD was suspended due to infiltrated muscle fibers. Subsequently, he underwent laparoscopic sigmoidectomy with hand-sewn anastomosis, accompanied by D3 lymph node dissection. Histopathological findings revealed a well-differentiated tubular adenocarcinoma, pT2(MP), tub1>tub2>por2, ly0, v1, PM0, DM0, RM0, N0M0, pStageⅠ. The follow-up CT 6 months after surgery, showed enhanced wall thickening and irregular surface of the sigmoid colon. Colonoscopy revealed a type 2 tumor located on the anastomotic line. Based on the diagnosis of anastomotic recurrence, the patient underwent partial colectomy. Histopathological findings were similar to those of the primary tumor and suggested implantation of exfoliated cancer cells as the origin of anastomotic recurrence. Cancer cells had infiltrated all layers. In conclusion, we recommend the performance of appropriate operative procedures to prevent anastomotic recurrence, such as the cleaning of the anastomosed intestinal tract. Careful follow-up in colon cancer patients is of the utmost importance and the risk of anastomotic recurrence should always be considered.
要旨
症例は78歳,男性。S状結腸癌Ⅱa病変に対し,内視鏡的粘膜下層剝離術(endoscopic submucosal dissection: ESD)を施行した。筋層浸潤像を認めたためESDを中断し,2か月後に腹腔鏡下S状結腸切除術を施行した。手縫い吻合にて再建し,病理組織学的所見は高分化管状腺癌,type 2,2.1×1.7 cm,pT2(MP),tub1>tub2>por2,ly0,v1,N0(0/11),PM0,DM0,RM0,pStageⅠであった。術後6か月のCTにてS状結腸に造影効果を伴う壁肥厚を認め,大腸内視鏡検査で吻合部上に2型進行癌を認めた。吻合部再発と診断し,結腸部分切除術を施行した。病理組織学的所見は初回手術と同様の組織像であり,癌細胞は全層性に浸潤していた。本症例では原発巣手術における腫瘍遺残の可能性は低く,遊離癌細胞のimplantationによる再発と考えられた。吻合部の清拭など予防策を行うこと,そして術後早期再発の可能性を考慮し慎重に経過観察を行うことが重要と考える。
目次
We report a case of anastomotic recurrence following laparoscopic sigmoidectomy with hand-sewn anastomosis, which was attributable to the implantation of exfoliated cancer cells. A 78-year-old man diagnosed with early colon cancer underwent endoscopic submucosal dissection(ESD); however, ESD was suspended due to infiltrated muscle fibers. Subsequently, he underwent laparoscopic sigmoidectomy with hand-sewn anastomosis, accompanied by D3 lymph node dissection. Histopathological findings revealed a well-differentiated tubular adenocarcinoma, pT2(MP), tub1>tub2>por2, ly0, v1, PM0, DM0, RM0, N0M0, pStageⅠ. The follow-up CT 6 months after surgery, showed enhanced wall thickening and irregular surface of the sigmoid colon. Colonoscopy revealed a type 2 tumor located on the anastomotic line. Based on the diagnosis of anastomotic recurrence, the patient underwent partial colectomy. Histopathological findings were similar to those of the primary tumor and suggested implantation of exfoliated cancer cells as the origin of anastomotic recurrence. Cancer cells had infiltrated all layers. In conclusion, we recommend the performance of appropriate operative procedures to prevent anastomotic recurrence, such as the cleaning of the anastomosed intestinal tract. Careful follow-up in colon cancer patients is of the utmost importance and the risk of anastomotic recurrence should always be considered.
要旨
症例は78歳,男性。S状結腸癌Ⅱa病変に対し,内視鏡的粘膜下層剝離術(endoscopic submucosal dissection: ESD)を施行した。筋層浸潤像を認めたためESDを中断し,2か月後に腹腔鏡下S状結腸切除術を施行した。手縫い吻合にて再建し,病理組織学的所見は高分化管状腺癌,type 2,2.1×1.7 cm,pT2(MP),tub1>tub2>por2,ly0,v1,N0(0/11),PM0,DM0,RM0,pStageⅠであった。術後6か月のCTにてS状結腸に造影効果を伴う壁肥厚を認め,大腸内視鏡検査で吻合部上に2型進行癌を認めた。吻合部再発と診断し,結腸部分切除術を施行した。病理組織学的所見は初回手術と同様の組織像であり,癌細胞は全層性に浸潤していた。本症例では原発巣手術における腫瘍遺残の可能性は低く,遊離癌細胞のimplantationによる再発と考えられた。吻合部の清拭など予防策を行うこと,そして術後早期再発の可能性を考慮し慎重に経過観察を行うことが重要と考える。