Anastomotic Recurrence of Sigmoid Colon Cancer over Five Years after Surgery
A 65-year-old female had a history of several cancers, including left breast cancer at 36 years of age, cecum cancer in her forties and right breast cancer at 64 years of age. Her mother, younger sister and daughter also each had a history of breast cancer. At 60 years of age, the patient underwent sigmoidectomy and right colectomy with D3 lymph node dissection for both sigmoid colon cancer (fig. ) and transverse colon cancer. During that operation, lavage of the remnant colon was performed before anastomosis, and automatic anastomotic devices were used. The pathological diagnoses revealed both sigmoid colon cancer and transverse colon cancer of T3N0M0, stage IIA. Both the oral and anal margins of the resected colon had a sufficient length: the transverse margin measured 135 mm (oral wedge) and 50 mm (anal wedge), while the sigmoid margin measured 40 mm (oral wedge) and 50 mm (anal wedge) (fig. ). At 3-year follow-up, colonoscopy and computed tomography revealed no signs of recurrence (fig. ). At 5-year follow-up, colonoscopy demonstrated surrounding flaring and swelling in the anastomotic area of the sigmoid colon (fig. ). A biopsy revealed an adenocarcinoma. The levels of the tumor markers CEA and CA19-9 were both within the normal limits at that time. There were no signs of recurrence in other locations, such as the liver and lungs, or other areas of the remnant colon. Therefore, under a diagnosis of anastomotic recurrence over 5 years after surgery, we performed lower anterior resection. The tumor measured 45 × 35 mm and was located at the previous anastomotic site (fig. ). Pathology revealed histological features that resembled the pattern of the previous tumor, and there were masses of cancerous cells in the subserosal and muscular layers near the fissured muscular layer, which comprised the anastomotic area (fig. ). In addition, in the mucous membranes surrounding the anastomotic area, there was hyperplasia of cancerous cells that pushed up layers from deeper mucous membranes. Furthermore, there were no cancerous cells in the mucous membranes, which indicated that the cells were derived from the primary lesion (fig. ). Based on these observations, the final diagnosis was anastomotic recurrence of sigmoid colon cancer after surgery. No lymph node metastasis was observed among the 18 dissected lymph nodes. There have been no signs of recurrence for the 2 years since the last surgery.