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Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report.

Kishino T, Matsuda T, Sakamoto T, Nakajima T, Taniguchi H, Yamamoto S, Saito Y - BMC Gastroenterol (2010)

Bottom Line: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up.The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding.The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

ABSTRACT

Background: The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.

Case presentation: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

Conclusion: When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.

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Follow up colonoscopy 3years after initial EPMR treatment. The scar was observed at the site of EPMR.
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Figure 2: Follow up colonoscopy 3years after initial EPMR treatment. The scar was observed at the site of EPMR.

Mentions: Histopathological examination revealed a well differentiated adenocarcinoma with low grade atypia, and the depth of invasion was intramucosa without lymphovascular invasion, cut end margin negative (Figure 1). We considered the treatment to be a curative resection. Follow up colonoscopy was performed 1 and 3 years after endoscopic resection. The EPMR scar was recognized without any residual or recurrent lesion in the follow up (Figure 2). Follow up colonoscopy was scheduled at 5 years after treatment, but cancelled for personal reasons.


Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report.

Kishino T, Matsuda T, Sakamoto T, Nakajima T, Taniguchi H, Yamamoto S, Saito Y - BMC Gastroenterol (2010)

Follow up colonoscopy 3years after initial EPMR treatment. The scar was observed at the site of EPMR.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2925815&req=5

Figure 2: Follow up colonoscopy 3years after initial EPMR treatment. The scar was observed at the site of EPMR.
Mentions: Histopathological examination revealed a well differentiated adenocarcinoma with low grade atypia, and the depth of invasion was intramucosa without lymphovascular invasion, cut end margin negative (Figure 1). We considered the treatment to be a curative resection. Follow up colonoscopy was performed 1 and 3 years after endoscopic resection. The EPMR scar was recognized without any residual or recurrent lesion in the follow up (Figure 2). Follow up colonoscopy was scheduled at 5 years after treatment, but cancelled for personal reasons.

Bottom Line: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up.The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding.The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

ABSTRACT

Background: The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.

Case presentation: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

Conclusion: When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.

Show MeSH
Related in: MedlinePlus