Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Putz City, Chiayi, Taiwan.
Jpn J Clin Oncol. 2012 Aug;42(8):753-6. doi: 10.1093/jjco/hys081. Epub 2012 May 28.
Metastasis at the colostomy site is rare. Most reported patients with such metastases undergo abdominoperineal resection and this kind of metastases happened after a longer period post-cancer surgery. In our patient, because it happened during a short interval between rectal cancer surgery and stoma closure, colostomy site metastasis probably occurred owing to ablative cancer cell reflux and seeding from the obstruction during decompressive colostomy rather than local, lymphatic or haematogenous spread. Meticulous histologic analyses to rule out undetected, concomitant polyps and metachronous cancer are very important for patients with obstructive colorectal cancer who undergo decompressive colostomy. The potential risk of colostomy site metastasis during staged surgery for obstructive colorectal cancer remains uncertain; however, the result from this case report raises the question of such a risk for further studies in a greater number of patients.
肠造口部位转移较为罕见。大多数报道的此类转移患者接受腹会阴切除术，且这种转移发生在癌症手术后较长时间。在我们的患者中，由于其发生在直肠癌手术后和造口关闭之间的较短时间内，造口部位转移可能是由于减压性肠造口过程中梗阻导致消融癌细胞反流和播种，而不是局部、淋巴或血行播散所致。对于接受减压性肠造口的梗阻性结直肠癌患者，仔细的组织学分析对于排除未检出的同时性息肉和异时性癌症非常重要。在梗阻性结直肠癌的分期手术中，肠造口部位转移的潜在风险尚不确定；然而，该病例报告的结果提出了在更多患者中进一步研究这种风险的问题。
