Yonenaga Yoshikuni, Yokoyama Satoshi
Department of Surgery, Ako City Hospital, Ako 678-0232, Hyogo, Japan.
Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Wakayama, Japan.
World J Clin Cases. 2021 Oct 16;9(29):8923-8931. doi: 10.12998/wjcc.v9.i29.8923.
The duration of surveillance after curative resection of colorectal cancer (CRC) is generally 5 years. The overall incidence of recurrence more than 5 years after surgery for CRC in Japan has been reported to be 0.6%. Moreover, it is rare for CRC to have metachronous liver metastasis more than 10 years after surgery. Here, we present a case of liver metastasis detected 11 years after the curative resection of rectal cancer.
A 72-year-old man was referred to our hospital after a liver tumor was detected by abdominal ultrasonography at another hospital. He had undergone surgery for rectal cancer 11 years previously. Contrast-enhanced computed tomography (CT) showed a tumor with a diameter of approximately 8 cm in the posterior segment, which was weakly and gradually enhanced. F-fluorodeoxyglucose-positron emission tomography/CT showed an abnormally high uptake on the tumorous lesion, which showed that the tumor appeared to spread convexly along the intrahepatic bile ducts. Intrahepatic cholangiocarcinoma was therefore diagnosed, and he had an extended right posterior sectionectomy and regional lymph node dissection. Histopathological examination showed that the tumor was a moderately differentiated adenocarcinoma and showed the same pathological characteristics as the rectal cancer. Immunohistological examination showed that the cancer cells of both the liver tumor and rectal cancer were positive for cytokeratin (CK) 20 and weakly positive for CK 7. These findings were consistent with the liver metastasis from the rectal cancer.
It is possible that a liver tumor is metastatic in a patient with a previous history of CRC, even if it was more than 10 years earlier.
结直肠癌（CRC）根治性切除术后的监测期一般为5年。据报道，日本CRC术后5年以上复发的总体发生率为0.6%。此外，CRC术后10年以上出现异时性肝转移的情况较为罕见。在此，我们报告1例直肠癌根治性切除术后11年发现肝转移的病例。
一名72岁男性在另一家医院经腹部超声检查发现肝脏肿瘤后转诊至我院。他11年前曾接受直肠癌手术。增强计算机断层扫描（CT）显示肝右后段有一个直径约8 cm的肿瘤，呈轻度且逐渐增强。F-氟脱氧葡萄糖正电子发射断层扫描/CT显示肿瘤病灶摄取异常增高，提示肿瘤似乎沿肝内胆管呈凸性扩散。因此诊断为肝内胆管癌，患者接受了扩大右后叶切除术及区域淋巴结清扫术。组织病理学检查显示肿瘤为中分化腺癌，与直肠癌具有相同的病理特征。免疫组织学检查显示肝肿瘤和直肠癌的癌细胞细胞角蛋白（CK）20均为阳性，CK7弱阳性。这些结果与直肠癌肝转移相符。
既往有CRC病史的患者，即使是在10多年前发病，肝脏肿瘤也有可能是转移性的。
