Yokoe Takamichi, Sato Michio, Yahagi Masashi, Dogru Murat, Fujisaki Hiroto, Ogura Masaharu, Kawamata Hiroshi, Asahara Fumitaka, Takayama Shin, Harada Hirohisa, Tanaka Yoichi, Miyauchi Jun, Matsui Junichi
Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Case Rep Oncol. 2020 Mar 19;13(1):225-232. doi: 10.1159/000505392. eCollection 2020 Jan-Apr.
We report the case of a 65-year-old male who developed heterochronous local recurrences of gastric cancer in the jejunal pouch (J-pouch) four times after total gastrectomy. He underwent total gastrectomy, J-pouch, and Roux-en-Y reconstruction for stage II gastric cancer in 2005. Four local recurrences appeared on the esophago-jejunal anastomosis, the suture line within the pouch, the esophago-jejunal anastomosis, and the anastomosis between the jejunum and Y-loop, which were resected by partial excision or endoscopic submucosal dissection. Suture line recurrence of gastric cancer is rare. The common features for each recurrence included the surgically negative resection margins, observation of the same histopathological subtype, absence of remote metastasis or peritoneal seeding, and the recurrence on the anastomotic suture line, suggesting that the cause of recurrence was the implantation of exfoliated cancer cells probably in the suture line. However, there is no established procedure for preventing implantation recurrence currently, the effectiveness of lumen lavage is suggested.
我们报告了一例65岁男性患者的病例，该患者在全胃切除术后空肠袋（J袋）出现了4次异时性胃癌局部复发。他于2005年因II期胃癌接受了全胃切除术、J袋和Roux-en-Y重建术。4次局部复发分别出现在食管空肠吻合口、袋内缝合线处、食管空肠吻合口以及空肠与Y形袢之间的吻合口，通过局部切除或内镜黏膜下剥离术进行了切除。胃癌缝合线复发较为罕见。每次复发的共同特征包括手术切缘阴性、观察到相同的组织病理学亚型、无远处转移或腹膜种植，且复发发生在吻合口缝合线处，提示复发原因可能是脱落的癌细胞种植于缝合线处。然而，目前尚无预防种植性复发的确立方法，有人提出肠腔灌洗可能有效。
