Chandra Aninda, Lee Lester, Hossain Fahad, Johal Harnaik
Department of General Surgery, Queen Mary's Hospital Sidcup, Sidcup, UK.
World J Surg Oncol. 2008 Jan 17;6:5. doi: 10.1186/1477-7819-6-5.
The reported case illustrates an instance of colonic adenocarcinoma presenting as an isolated tumour 3 1/2 years after open surgery. The presentation was in some respects unique as it was complicated by an incisional hernia and occurred in the anterior abdominal wall. A literature review was performed.
An 83 year old lady initially underwent an extended right open hemicolectomy for a mid-transverse colonic adenocarcinoma (T4N2M0). No adjacent structures were involved. After adjuvant chemotherapy, she was kept under regular surveillance. A CT scan and colonoscopy at one year were normal. At 18 months investigations including an ultrasound scan of the liver and a radioisotope bone scan were all negative. Over three and half years later the patient presented with an incisional hernia. Repeat CT scan and tumour markers were reported as negative. At operation, a mass was found within the anterior abdominal wall complicating the incisional hernia. This mass was widely resected and a laparotomy performed. Histology confirmed an adenocarcinoma of colonic origin extending to one of the lateral margins. A post-operative PET scan confirmed the absence of intra-abdominal pathology.
The literature regarding recurrence of colonic tumours after open surgery reports low incidences of this occurring within abdominal incisions. The literature indicates prognosis is poor, but the numbers are small and distinction is often not made between isolated recurrence and those with other sites of tumour recurrence. In order to avoid missing isolated wound implantation, careful consideration should be given to those who present with new pathology related to previous cancer surgery incisions, both clinically and radiologically.
所报告的病例显示了一例结肠腺癌在开放手术后3年半以孤立肿瘤形式出现的情况。该病例的表现在某些方面较为独特，因为它并发了切口疝，且发生在前腹壁。进行了文献综述。
一位83岁女性最初因横结肠中段腺癌（T4N2M0）接受了扩大右半结肠开放切除术。未累及相邻结构。辅助化疗后，她接受定期监测。术后1年的CT扫描和结肠镜检查均正常。18个月时包括肝脏超声扫描和放射性核素骨扫描在内的各项检查均为阴性。三年半后，患者出现切口疝。复查CT扫描和肿瘤标志物报告均为阴性。手术时，在前腹壁发现一个肿物，使切口疝病情复杂化。该肿物被广泛切除，并进行了剖腹手术。组织学证实为结肠源性腺癌，已延伸至一侧切缘。术后PET扫描证实腹腔内无病变。
关于开放手术后结肠肿瘤复发的文献报道，这种情况在腹部切口处发生的发生率较低。文献表明预后较差，但病例数量较少，且通常未区分孤立性复发和伴有其他部位肿瘤复发的情况。为避免漏诊孤立的伤口种植，对于那些出现与既往癌症手术切口相关新病变的患者，应从临床和影像学方面进行仔细评估。
