Metachronous adenoma on ileorectal anastomosis suture line and submucosal deep invasive cancer suspected of rapid growth in rectal remnant following long-term interval after curative surgery for advanced colon cancer

Toshio Uraoka, Joichiro Horii, Osamu Goto, Masayuki Shimoda, Naohisa Yahagi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

There is general agreement as to the value of postoperative surveillance and the effectiveness of colonoscopy in the early detection of metachronous colorectal lesions. In the present case, a 56-year-old woman with no family history of colon cancer underwent surveillance colonoscopy in which a metachronous flat adenoma was detected following an interval of 23 years after a colectomy and 20 years subsequent to treatment for uterine cancer. A second metachronous flat lesion histopathologically determined to be a submucosal (sm) deep invasive cancer with lymphovascular involvement was detected 12 months later. This second metachronous lesion was suspected of having developed rapidly in the rectal remnant accounting for its sm deep invasion. The findings of this case suggest colonoscopy surveillance guidelines proposed for individuals at high risk should be evaluatedbased on cancer history and an analysis of possible mismatch repair gene mutations. In addition, the first metachronous lesion was located directly on the suture line of the anastomosis. Endoscopic submucosal dissection (ESD) was indicated despite severe fibrosis into the sm layer. This case also demonstrates the successful use of improved ESD instruments, sm injection agents and technique refinements in the treatment of a technically difficult lesion with a high risk of complications.

Original languageEnglish
Pages (from-to)46-51
Number of pages6
JournalDigestive Endoscopy
Volume25
Issue numberSUPPL.2
DOIs
Publication statusPublished - 2013 May 1

Keywords

  • endoscopic submucosal dissection (ESD)
  • interval cancer
  • submucosal invasive cancer
  • surveillance colonoscopy
  • suture line of the anastomosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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