Noji Takehiro, Yamamura Yoshiyuki, Muto Jun, Kuroda Aki, Koinuma Junkichi, Yoshioka Tatsuya, Murakawa Katsuhiko, Otake Setsuyuki, Hirano Satoshi, Ono Koichi
Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan; Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
Int J Surg Case Rep. 2014;5(12):954-7. doi: 10.1016/j.ijscr.2014.10.005. Epub 2014 Oct 19.
Intestinal metastasis from gastric cancer is rare, although the most common cause of secondary neoplastic infiltration of the colon is gastric cancer. However, little data is available on recurrence or death in patients with gastric cancer surviving >5 years post-gastrectomy. Here we report two cases of lower intestinal metastasis from gastric cancer >5 years after primary resection and discuss with reference to the literature.
Case 1: A 61-year-old man with a history of total gastrectomy for gastric cancer 9 years earlier was referred to our hospital with constipation and abdominal distention. We diagnosed primary colon cancer and subsequently performed extended left hemicolectomy. Histological examination revealed poorly differentiated adenocarcinoma resembling the gastric tumor he had 9 years earlier. The patient refused postoperative adjuvant chemotherapy and remained alive with cancerous peritonitis and skin metastases as of 17 months later. Case 2: A 46-year-old woman with a history of total gastrectomy for gastric cancer 9 years earlier presented with constipation. She also had a history of Krukenberg tumor 3 years earlier. We diagnosed metastatic rectal cancer and subsequently performed low anterior resection and hysterectomy. Pathological examination revealed poorly differentiated tubular adenocarcinoma, resembling the gastric tumor. The patient remained alive without recurrence as of 17 months later.
We found 19 reported cases of patients with resection of colon metastases from gastric cancer. Median disease-free interval was 74 months.
Resection of late-onset colorectal recurrence from gastric cancer appears worthwhile for selected patients.
尽管结肠癌继发性肿瘤浸润最常见的原因是胃癌，但胃癌的肠转移很少见。然而，关于胃癌患者胃切除术后存活超过5年的复发或死亡数据很少。在此，我们报告2例原发性切除术后5年以上发生的胃癌低位肠转移病例，并结合文献进行讨论。
病例1：一名61岁男性，9年前因胃癌接受全胃切除术，因便秘和腹胀转诊至我院。我们诊断为原发性结肠癌，随后进行了扩大左半结肠切除术。组织学检查显示为低分化腺癌，与他9年前的胃肿瘤相似。患者拒绝术后辅助化疗，截至17个月后，因癌性腹膜炎和皮肤转移仍存活。病例2：一名46岁女性，9年前因胃癌接受全胃切除术，出现便秘。她3年前还患有库肯勃瘤。我们诊断为转移性直肠癌，随后进行了低位前切除术和子宫切除术。病理检查显示为低分化管状腺癌，与胃肿瘤相似。截至17个月后，患者无复发存活。
我们发现19例报告的胃癌结肠转移灶切除患者。无病间期中位数为74个月。
对于部分患者，切除胃癌晚期结直肠复发灶似乎是值得的。
