van Lieshout A S, Grüter A A J, Smits L J H, Tanis P J, Tuynman J B
Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, the Netherlands.
Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, the Netherlands; Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands.
Int J Surg Case Rep. 2022 Apr;93:106891. doi: 10.1016/j.ijscr.2022.106891. Epub 2022 Mar 1.
Invasive procedures for colorectal cancer can cause iatrogenic tumor cell seeding. Implantation of these exfoliated cells in the surrounding tissue can result in locoregional cancer recurrence. This has been described in endoscopic procedures and major surgical resections, however recurrence in iatrogenic lesions of the anal canal during minimal invasive rectal surgery has not been shown in literature yet. This is the first reported case of recurrent rectal cancer that developed into an anal metastasis at the site where hooks of the Lone Star Retractor disrupted the epithelial lining of the anal canal during a local excision of early rectal cancer using TAMIS.
A 57 year old male was diagnosed with a high risk early stage rectal adenocarcinoma. He was treated with transanal minimally invasive surgery (TAMIS) with the use of a Lone Star retractor and he received subsequent chemo-radiotherapy. 23 months later the patient developed a bleeding mass bulging out of the anus. A true cut and incision biopsy was performed and the pathology report revealed localization of adenocarcinoma at the anal canal which was similar to the earlier diagnosed rectal carcinoma. The patient underwent an abdominal perineal resection and left-sided lymph node dissection.
This shows that local recurrence through implantation of exfoliated tumor cells can occur in iatrogenic lesions of the anal canal not only in major but also in minimal invasive rectal surgery. Careful tissue handling and rectal washout may reduce the chance of this implantation metastasis.
结直肠癌的侵入性手术可导致医源性肿瘤细胞播散。这些脱落细胞植入周围组织可导致局部癌症复发。这在内镜手术和大型手术切除中已有描述，然而，文献中尚未显示在微创直肠手术期间肛管医源性病变中的复发情况。这是首例报告的复发性直肠癌病例，在使用经肛门微创手术系统（TAMIS）局部切除早期直肠癌过程中，Lone Star牵开器的钩子破坏肛管上皮衬里的部位发展为肛门转移瘤。
一名57岁男性被诊断为高危早期直肠腺癌。他接受了使用Lone Star牵开器的经肛门微创手术（TAMIS），随后接受了放化疗。23个月后，患者出现一个从肛门突出的出血性肿块。进行了真正的切割和切口活检，病理报告显示肛管腺癌的定位与早期诊断的直肠癌相似。患者接受了腹会阴联合切除术和左侧淋巴结清扫术。
这表明，不仅在大型直肠手术中，而且在微创直肠手术中，通过脱落肿瘤细胞植入导致的局部复发都可能发生在肛管医源性病变中。小心处理组织和直肠冲洗可能会降低这种植入转移的机会。
