Institute of Gastroenterology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan.
Med Sci Monit. 2012 Jul;18(7):CS53-6. doi: 10.12659/msm.883196.
Late-onset and solitary recurrence of gastric signet ring cell (SRC) carcinoma is rare. We report a successful surgical resection of late solitary locoregional recurrence after curative gastrectomy for gastric SRC carcinoma.
The patient underwent total gastrectomy for advanced gastric carcinoma at age 52. Seven years after the primary operation, he visited us again with sudden onset of abdominal pain and vomiting. We finally decided to perform an operation, based on a diagnosis of colon obstruction due to the recurrence of gastric cancer by clinical findings and instrumental examinations. The laparotomic intra-abdominal findings showed that the recurrent tumor existed in the region surrounded by the left diaphragm, colon of splenic flexure, and pancreas tail. There was no evidence of peritoneal dissemination, and peritoneal lavage fluid cytology was negative. We performed complete resection of the recurrent tumor with partial colectomy, distal pancreatectomy, and partial diaphragmectomy. Histological examination of the resected specimen revealed SRC carcinoma, identical in appearance to the previously resected gastric cancer. We confirmed that the intra-abdominal tumor was a locoregional gastric cancer recurrence in the stomach bed. The patient showed a long-term survival of 27 months after the second operation.
In the absence of effective alternative treatment for recurrent gastric carcinoma, surgical options should be pursued, especially for late and solitary recurrence.
胃印戒细胞癌（SRC）的晚期和单发复发较为罕见。我们报告了一例胃 SRC 癌根治性胃切除术后晚期单发局部复发成功手术切除的病例。
该患者 52 岁时因进展期胃癌行全胃切除术。根治性手术后 7 年，他因突发腹痛和呕吐再次就诊。根据临床和影像学检查结果诊断为胃癌复发引起的结肠梗阻，我们最终决定手术治疗。剖腹探查的腹腔内发现显示，复发性肿瘤存在于左膈肌、脾曲结肠和胰腺尾部周围区域。没有腹膜扩散的证据，腹腔灌洗液细胞学检查为阴性。我们行包括部分结肠切除术、远端胰腺切除术和部分膈肌切除术的完整复发性肿瘤切除术。切除标本的组织学检查显示 SRC 癌，与先前切除的胃癌表现相同。我们确认腹腔内肿瘤是胃床局部复发性胃癌。患者在第二次手术后长期生存 27 个月。
对于复发性胃癌，如果没有有效的替代治疗方法，应选择手术治疗，尤其是对于晚期和单发复发的患者。
