-Case Reports-

Recurrence of Colonic Cancer Twice at the Site of Stapled Colorectal Anastomosis

Ryouhei Futami^1,2, Kimiyoshi Shimanuki², Atsushi Sugiura², Yoshikazu Tsuchiya², Masahiro Kaneko², Keiichi Okawa², Sho Mineta², Yoshihiko Sugiyama³, Koho Akimaru¹ and Takashi Tajiri¹

¹Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
²Department of Surgery, Aizu Central Hospital, Fukushima
³Department of Pathology, Aizu Central Hospital, Fukushima

Recurrence at the site of a stapled anastomosis is generally believed to result from the luminal implantation of viable cancer cells during stapling. We report a case in which colon cancer recurred twice at the site of a stapled anastomosis, despite povidone iodine (PVP-I) lavage consisting of an enema with 5% PVP-I solution before the operation and intraoperative lavage of the rectal remnant and the descending colon with a 10% PVP-I solution. Three months after sigmoidectomy to resect a carcinoma of the sigmoid colon, a circular anastomotic recurrence was found at the suture line after anastomosis with a stapler. However, 11 months after the subsequent resection and reanastomosis to remove the first anastomotic recurrence, another anastomotic recurrence was found. We performed abdominoperineal resection for the second recurrence at the site of the stapled anastomosis. Suture-line recurrence could not be prevented in the present case despite lavage with a PVP-I solution for prophylaxis.

J Nippon Med Sch 2007; 74: 251-256

Keywords
anastomotic recurrence, stapled anastomosis, colorectum

Correspondence to
Ryouhei Futami, Department of Surgery (Divisions of Gastroenterology, General, Breast and Transplant), Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
ryouhei@nms.ac.jp

Received, February 26, 2007
Accepted, April 18, 2007