A Case of Hematogenous Small Bowel Metastasis from Colon Cancer after Colectomy

Abstract

The patient was a 64-year-old woman who underwent right hemicolectomy for double cancer of the cecum and ascending colon ; it was diagnosed as pT4a(SE)N1M0 Stage IIIa. After adjuvant chemotherapy, she had been followed without recurrence until a tumor of the small intestine was detected by an abdominal/pelvic CT scan 51 months after the colectomy. Small bowel metastasis or primary tumor of the small intestine was suspected, and we performed partial resection of the small intestine. Intraoperative findings disclosed a 10×35 mm ridging lesion encircling the whole circumference of the bowel at 210 cm proximal to the anastomosed site at the previous operation. There was no gross infiltration into the serous surface. Histopathological survey demonstrated the lesion to be solitary hematogenous metastasis of colon cancer, because a clearly demarcated tumor composed of tubular and mucous adenocarcinoma which was similar to the specimen of resected colon cancer was identified. According to her hope, adjuvant chemotherapy was not added. The patient has been relapse-free as of 30 months after the operation. Hematogenous metastasis of colon cancer to the small intestine is rare and there are few reports on the treatments and prognosis. In the recent 30 years in Japan, only 15 patients with hematogenous colon cancer metastasis to the small intestine who underwent surgical resection are reported. Including ours, 13 patients were reported to have been relapse-free, two had recurrence and one died of cancer progression 71 months after the second surgery. Although the relapse-free survival periods are reported to be from nine to 120 months after bowel resection, five patients had earned five years or longer survival. Throughout relatively extended survival period of them, even though the treatment strategy has not statistically established, surgical treatment would improve the prognosis of patients with solitary metastasis of colon cancer to the small intestine.