Namikawa Tsutomu, Kobayashi Michiya, Okamoto Ken, Okabayashi Takehiro, Akimori Toyokazu, Sugimoto Takeki, Hanazaki Kazuhiro
Department of Tumor Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan.
Gastric Cancer. 2007;10(4):256-9. doi: 10.1007/s10120-007-0441-8. Epub 2007 Dec 25.
We herein present a case of recurrence of gastric cancer in the jejunal pouch after total gastrectomy in a 74-year-old man. He had a history of two operations for gastric cancer. The second operation was a completion gastrectomy with jejunal pouch reconstruction and regional lymphadenectomy, for gastric cancer in the cardia of the remnant stomach, performed 2 years and 9 months before the present admission. A follow-up endoscopy showed three elevated tumors along the suture lines in the jejunal pouch in the upper digestive tract. Resection of the jejunal pouch was performed. Gross pathological examination revealed elevated lesions along the staple suture lines in the jejunal pouch. Histopathologically, moderately differentiated tubular adenocarcinoma involving the muscular layer, without lymphatic metastases, was recognized. Recurrence of gastric cancer in the jejunal pouch after resection is rare. We suggest that implantation of exfoliated cancer cells gave rise to the recurrence of tumors on the suture line in this patient. We also review two cases of gastric cancer in the jejunal pouch after resection previously described in the literature.
我们在此报告一例74岁男性全胃切除术后空肠袋胃癌复发的病例。他有过两次胃癌手术史。第二次手术是残胃贲门部胃癌的根治性全胃切除、空肠袋重建及区域淋巴结清扫术，于本次入院前2年9个月进行。随访内镜检查发现上消化道空肠袋缝合线处有3个隆起性肿物。遂行空肠袋切除术。大体病理检查显示空肠袋吻合钉缝合线处有隆起性病变。组织病理学检查发现为中分化管状腺癌，侵犯肌层，无淋巴结转移。空肠袋切除术后胃癌复发罕见。我们认为该患者缝线处肿瘤复发是由于脱落癌细胞种植所致。我们还回顾了文献中先前报道的2例空肠袋胃癌切除术后病例。
