Ltaimi Ahmed, Hasnaoui Anis, Triki Wissem, Baraket Oussema, Bouchoucha Sami
Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Bougatfa Hospital, Tunisia.
Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Menzel Bourguiba Hospital, Tunisia.
Int J Surg Case Rep. 2024 Sep;122:110163. doi: 10.1016/j.ijscr.2024.110163. Epub 2024 Aug 13.
Colon carcinoma is the most common type of gastro-intestinal cancer. Despite radical surgery, locoregional recurrence has been observed in 4-11.5 % of patients. Abdominal wall metastasis at the drainage site is an extremely rare finding and only a few cases are described in the literature. The mechanism of this metastasis is unknown, and its management remains unclear due to the rarity of the condition.
A 66-year-old patient underwent left colectomy for locally advanced colonic adenocarcinoma. Eight months after the end of adjuvant chemotherapy, the patient complained of a progressive mass of the left lumbar centered on the previous drain site scar. Abdominal wall recurrence was suspected. The patient had R0 mass excision. Histopathologic examination showed a parietal infiltration by a colloid adenocarcinoma. The patient underwent adjuvant chemotherapy. No recurrence was observed.
Since 1999 only six cases of colon cancer drainage site metastasis have been reported. Metachronous solitary abdominal wall metastasis after radical colectomy may occur via cancer cell implantation, lymphatic or hematogenous route, or direct invasion. In case of drain site metastasis, the most likely hypothesis is the implantation of tumor cells into the abdominal wall through the drainage route performed during surgery.
The appearance of abdominal wall mass after colon cancer resection must always be considered suspicious. To reduce the risk of abdominal wall metastasis we recommend minimizing tumor manipulation, resection the route of previous percutaneous drainage and performing a radical surgery. Metastasis resection combined with chemotherapy is the appropriate approach to treat these metastases.
结肠癌是最常见的胃肠道癌症类型。尽管进行了根治性手术，但仍有4%-11.5%的患者出现局部区域复发。引流部位的腹壁转移是一种极为罕见的情况，文献中仅描述了少数病例。这种转移的机制尚不清楚，由于病例罕见，其治疗方法仍不明确。
一名66岁患者因局部晚期结肠腺癌接受了左半结肠切除术。辅助化疗结束8个月后，患者主诉以先前引流部位瘢痕为中心的左腰部出现进行性肿块。怀疑为腹壁复发。患者接受了R0肿块切除术。组织病理学检查显示为黏液腺癌的壁层浸润。患者接受了辅助化疗。未观察到复发。
自1999年以来，仅报告了6例结肠癌引流部位转移病例。根治性结肠切除术后异时性孤立性腹壁转移可能通过癌细胞种植、淋巴或血行途径或直接侵犯发生。对于引流部位转移，最可能的假说是肿瘤细胞通过手术期间进行的引流途径植入腹壁。
结肠癌切除术后腹壁肿块的出现必须始终被视为可疑。为降低腹壁转移的风险，我们建议尽量减少肿瘤操作，切除先前经皮引流的途径并进行根治性手术。转移灶切除联合化疗是治疗这些转移灶的合适方法。
