Department of Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
World J Surg Oncol. 2020 Apr 13;18(1):74. doi: 10.1186/s12957-020-01839-2.
Among gastrointestinal neuroendocrine tumors (NETs), rectal NETs account for about one-third of all tumors. Despite the occasional observation of lateral lymph node metastasis in patients with rectal NETs, lateral lymph node recurrence is rare. We present a rare case of lateral lymph node recurrence after curative resection of a rectal NET.
A 55-year-old man presented with fecal occult blood and colonoscopy revealed a mass in the distal rectum. Systematic computed tomography scan showed no evidence of regional lymph node or distant metastasis. The patient underwent laparoscopic intersphincteric resection and D2 lymph node dissection with diverting stoma. Diverting stoma closure was performed 6 months after the initial operation. Pathological diagnosis was NET of the rectum, grade 2, T1b, N0, Stage I without lymphovascular invasion. At 54 months after the surgery, recurrence in a left lateral lymph node was suspected and lymph node dissection was performed. The pathological diagnosis of the specimen was consistent with lateral lymph node metastasis of a recurrent rectal NET. To our best knowledge, there are no case reports in English of lateral lymph node recurrence after curative resection of a rectal NET, grade 2, T1b, N0, Stage I without lymphovascular invasion.
Considering that patients with lateral lymph node metastasis have worse survival than those without metastasis in rectal cancer, if complete resection of the tumor can be achieved for lateral lymph node recurrence, surgery may be an important option in the strategy to treat this condition.
在胃肠道神经内分泌肿瘤（NET）中，直肠 NET 约占所有肿瘤的三分之一。尽管在直肠 NET 患者中偶尔会观察到侧方淋巴结转移，但侧方淋巴结复发较为罕见。我们报告了一例直肠 NET 根治性切除术后发生侧方淋巴结复发的罕见病例。
一名 55 岁男性因粪便隐血就诊，结肠镜检查发现直肠远端有一肿块。系统计算机断层扫描未显示区域性淋巴结或远处转移的证据。患者接受了腹腔镜经括约肌间直肠切除术和 D2 淋巴结清扫术，并进行了转流造口术。初次手术后 6 个月进行了转流造口关闭术。病理诊断为直肠 NET，G2，T1b，N0，IA 期，无血管淋巴管侵犯。术后 54 个月，怀疑左侧侧方淋巴结复发，行淋巴结清扫术。标本的病理诊断与复发性直肠 NET 的侧方淋巴结转移一致。据我们所知，在英语文献中尚无直肠 NET，G2，T1b，N0，IA 期，无血管淋巴管侵犯，根治性切除术后发生侧方淋巴结复发的病例报告。
考虑到侧方淋巴结转移的患者在直肠癌中的生存率比无转移的患者差，如果能够对侧方淋巴结复发进行肿瘤完全切除，手术可能是治疗这种情况的策略中的一个重要选择。
