Solitary distant peritoneal metastasis of cecal cancer after laparoscopic colectomy: a case report

Abstract

INTRODUCTIONLaparoscopic colorectal resection, which is less invasive than open colorectal resection, has been increasingly used for colorectal cancer over the last two decades. Several large randomized controlled trials have reported the superiority in terms of shortterm outcomes, including earlier recovery of bowel function and shorter hospital stay to open colorectal resection (1 -4). These trials have also reported the equivalence in terms of long -term outcomes, including disease -free survival and overall survival to open colorectal resection (5 -7) ; however, several recurrence patterns peculiar to laparoscopic colorectal resection, such as port site recurrence and peritoneal seeding, are an issue in these days (8). Both port site recurrence and peritoneal seeding are related to careless surgical procedures. We have to pay close attention to our procedures during laparoscopic surgery.We report a case of solitary distant peritoneal metastasis of cecal cancer after laparoscopic colectomy. This peritoneal metastasis seemed to be caused by surgical procedures. The present case report highlights the importance of paying close attention to surgical procedure in laparoscopic surgery to prevent peritoneal seeding. CASE PRESENTATIONA 77 -year -old Japanese female underwent laparoscopic ileocecal resection and lymph node dissection for cecal cancer by a previous doctor. Pathological examination revealed moderately differentiated tubular adenocarcinoma with positive lymph and blood vessel invasion and serosal invasion. Lymph node metastases were seen in two of the seven dissected lymph nodes. Her pathologic stage was T4aN1bM0 stage IIIB according to the TNM Classification of Malignant Tumors 7th Edition. She had undergone adjuvant chemotherapy with oral capecitabine for 6 months. Two years and 9 months after the previous operation, contrast-enhanced computed tomography (CECT) during a routine examination revealed an intraperitoneal tumor at the right subphrenic fossa ; therefore, she presented to our hospital for the treatment of the tumor.There were no remarkable findings during the physical examination. Blood biochemistry showed elevation of carcinoembryonic antigen (6.2 ng/mL) and carbohydrate antigen 19 -9 (104.4 U/mL) levels. CECT showed an intraperitoneal tumor with poor contrast enhancement at the right subphrenic tumor. We performed magnetic resonance imaging with gadolinium ethoxybenzyl-L-diethylenetriamine pentaacetic acid (EOB -MRI) in addition, and EOB -MRI also showed the right subphrenic tumor, which seemed to be located on the right diaphragm and not invasive into the liver. (Figure 1). We also performed 18F-fluorodeoxyglucose position emission tomography (FDG-PET) for a qualitative diagnosis, and FDG-PET showed fluorodeoxyglucose accumulation in the right subphrenic tumor (Figure 2). There was no evidence of further peritoneal metastasis or another distant metastasis on a previous series of examinations ; therefore, we considered the tumor to be suspicious of solitary distant peritoneal metastasis of...

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Peritoneal spillage is not an issue in patients undergoing minimally invasive surgery for colorectal cancer

“…Reported cases of port site metastasis in the abdominal wall questioned the safety of the technique [14]. Besides, reports of rare cases of peritoneal spillage and port site seeding following laparoscopic resection of CRC have been worrisome [15,16]. Theoretically, peritoneal spillage and port site seeding may occur as a result of pressure on the tumor during dissection and/or retrieval of the colectomy specimen.…”