Isolated colostomy site recurrence in rectal cancer-two cases with review of literature

Chintamani,; Singhal, Vinay; Bansal, Anju; Bhatnagar, Divya; Saxena, Sunita

doi:10.1186/1477-7819-5-52

Cited by 27 publications

(21 citation statements)

References 8 publications

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“…In surgical operations, it is best not to expose the tumor. Cutaneous recurrence at the stoma closure suture after 5 years has been reported [ 12 ]. In this case, the tumor was not exposed because it was covered by a surgical glove.…”

Section: Discussionmentioning

confidence: 99%

Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

et al. 2015

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BackgroundCarcinomas occurring at colostomy sites are rare, and most of these are metachronous colorectal cancers. The median time between colostomy and development of a carcinoma at a colostomy site is 22 years, which exceeds the length of the recommended follow-up period. We report a rare case of a carcinoma of the transverse colon occurring at a colostomy site in a patient without a history of colorectal cancer.Case reportAn 89-year-old woman presented with a tumor occurring at a colostomy site. Thirty-five years previously, she had undergone a transverse loop colostomy for an iatrogenic colon perforation that occurred during left ureteral lithotomy. Upon physical examination, the patient had a hard nodule measuring 3 cm at the colostomy site. A biopsy of the nodule suggested adenocarcinoma, and the preoperative diagnosis was transverse colon cancer. A laparotomy was performed via a peristomal incision with 5-mm skin margins, and the tumor was covered by a surgical glove to avoid any tumor seeding. The colon was separated from the tumor by 5-cm margins, and the specimen was removed en bloc. An end colostomy was constructed to a new site on the right side of the abdomen. The deficit in the abdominal wall was repaired, and the skin was closed via a purse-string suture. The final diagnosis of the stoma tumor was transverse colon cancer (T2, N0, M0, stage I). One year and five months after surgery, there was no evidence of recurrence.ConclusionsThe occurrence of carcinomas at colostomy sites in patients without a history of colorectal cancer is rare. It is important to train ostomates to monitor the stoma for possible tumor recurrence.

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Section: Discussionmentioning

confidence: 99%

Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

et al. 2015

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“…Adenocarcinoma arising at a colostomy site is rare and only 10 cases have been reported previously in the English literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Almost all of these cases had a past history of malignancy, mainly in their rectum, and were considered as metachronous multiple colon cancers.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all of these cases had a past history of malignancy, mainly in their rectum, and were considered as metachronous multiple colon cancers. The exact etiology for these conditions has not been established because of its rare occurrence, but the following hypotheses have been proposed; (i) adenoma-carcinoma sequence, (ii) physical mucosal damage from persistent compression by clothing or stenosis, (iii) exposure to enterobacteria and bile acids in stool, (iv) cancer family syndrome, (v) de novo metaplasia, (vi) direct extension of the disease, (vii) hematogenous or lymphatic spread and (viii) implantation of exfoliated tumor cells (1,2). In the present case, adenocarcinoma at a colostomy site was identified as a primary tumor because the rectal tumor resected 27 years earlier had been revealed to be benign.…”

Section: Discussionmentioning

confidence: 99%

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Adenocarcinoma arising at a colostomy site with inguinal lymph node metastasis: report of a case

Iwamoto

Kawada

Hida

et al. 2014

Japanese Journal of Clinical Oncology

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Inguinal lymph node metastasis from adenocarcinoma arising at a colostomy site is extremely rare, and the significance of surgical resection for metastatic inguinal lymph nodes has not been established. An 82-year-old woman who had undergone abdominoperineal resection 27 years earlier was admitted to our hospital complaining of bleeding from a colostomy. Physical examination revealed that a tumor at the colostomy site directly invaded into the peristomal skin, and that a left inguinal lymph node was firm and swollen. Positron emission tomography/computed tomography scan demonstrated accumulation of 18 F-fluorodeoxy glucose into both the colostomy tumor and the left swollen inguinal lymph node, while there was no evidence of metastasis to liver or lungs. She underwent open left hemicolectomy with wide local resection of the colostomy, and dissection of left inguinal lymph nodes. Histological diagnosis was a moderately differentiated adenocarcinoma that directly invaded into the surrounding skin and metastasized to the left inguinal lymph node. The patient has been followed up for >5 years without any sign of recurrence. In general, inguinal lymph node metastasis from colorectal cancers is regarded as a systemic disease with a poor prognosis, and so systemic chemotherapy and radiotherapy, but not surgical lymph node dissection, are recommended. Considering the lymphatic drainage route in the present case, inguinal lymph node metastasis does not represent a systemic disease but rather a sentinel nodal metastasis from adenocarcinoma at a colostomy site. Surgical dissection of metastatic inguinal lymph nodes should be considered to enable a favorable prognosis in the absence of distant metastasis to other organs.

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“…However, there are no reports of ESD being performed through a stoma, a technically difficult approach because of air leakage and restricted scope maneuverability. Cancer recurrence on the stoma has been described after surgery [5], but metachronous lesions on the everted stoma have never been described. To summarize, endoscopic resections are possible in patients with a stoma and the right colon can be reached with an upper gastrointestinal scope, which has greater This document was downloaded for personal use only.…”

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confidence: 99%

Endoscopic resection and colonic stoma: endoscopic submucosal dissection at the hepatic flexure using an upper gastrointestinal scope and endoscopic mucosal resection by hand at the everted edge of the stoma

et al. 2016

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Endoscopic resection and colonic stoma: endoscopic submucosal dissection at the hepatic flexure using an upper gastrointestinal scope and endoscopic mucosal resection by hand at the everted edge of the stoma A 71-year-old man with a 6-cm, nongranular, laterally spreading tumor (NG-LST) at the hepatic flexure was referred to our unit for endoscopic submucosal dissection (ESD) because of a central depression in the lesion. He had previously undergone Hartmann's surgery [1] for a sigmoid adenocarcinoma (pT3N0M0) in April 2015. Surgeons preferred to maintain the stoma because of co-morbidities (amputation of both legs, diabetes, stroke). Thus, ESD was performed at the hepatic flexure via the stoma. Using an upper gastrointestinal scope (GIF 190; Olympus, Tokyo, Japan), we performed a complete R0 resection of a 5.4-cm, low grade dysplastic lesion, without any adverse events (During scope withdrawal, we detected six additional adenomas, and resected them completely by endoscopic mucosal resection (EMR). The final adenoma was detected at the everted edge of the stoma (• " Fig. 3, • " Fig. 4, • " Video 1). Endoscopic resection was impossible at this location owing to the lack of scope rigidity and stability to perform submucosal injection. Thus, we removed the scope and performed the procedure by hand using the endoscopic tools. It was actually easier because of better maneuverability and stability. This lesion was a low grade dysplasia and was resected completely (R0). In Japan, colonic ESD is the standard treatment for colonic NG-LSTs over 2 cm in size [2,3], and the procedure is now recommended by the European Society of Gastrointestinal Endoscopy [4]. However, there are no reports of ESD being performed through a stoma, a technically difficult approach because of air leakage and restricted scope maneuverability. Cancer recurrence on the stoma has been described after surgery [5], but metachronous lesions on the everted stoma have never been described. To summarize, endoscopic resections are possible in patients with a stoma and the right colon can be reached with an upper gastrointestinal scope, which has greater This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. maneuverability and control. For lesions on the everted part of the stoma, direct EMR by hand is probably easier than endoscopic techniques.

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Isolated colostomy site recurrence in rectal cancer-two cases with review of literature

Cited by 27 publications

References 8 publications

Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

Adenocarcinoma arising at a colostomy site with inguinal lymph node metastasis: report of a case

Endoscopic resection and colonic stoma: endoscopic submucosal dissection at the hepatic flexure using an upper gastrointestinal scope and endoscopic mucosal resection by hand at the everted edge of the stoma

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