A Six-year Survival Case of Advanced Sigmoid Colon Cancer with Metastases to Both the Virchow and Para-aortic Lymph-nodes

Hidefumi Baba, Katsunori Tanaka, Shigenao Kan, Fumio Suzuki, Hitoshi Otaka, Takao Moriya

Department of Surgery, Tachikawa Kyosai Hospital

We herein report a six-year survival case who had advanced sigmoid colon cancer with metastasis to Virchow's lymph-node. A 48-year-old woman presented with chief complaint of a tumor in the supra-clavicular fossa. An excisional biopsy of the tumor revealed cancer metastasis based on a histological examination of the specimen. The barium-enema and abdominal computed tomographic findings demonstrated advanced sigmoid colon cancer with para-aortic lymph-node swelling. Under a diagnosis of advanced sigmoid colon cancer with metastasis to Virchow's lymph-node and para-aortic lymph-node swelling, Hartmann's operation was performed along with a D4 lymphadenectomy. Histological examination of the resected specimens showed moderately to poorly differentiated adenocarcinoma with invasion to the subserosal layer and lymph vessel invasion in the subserosa. Many areas of lymph-node metastasis were diagnosed histologically, and the positive rate of the para-aortic lymph-nodes was 9/30 (30%). Tegafur and uracil (UFT) were thereafter admininstered orally for five years as postoperative adjuvant chemotherapy. The patient remains alive and well, without recurrence of the colon cancer, at 6 years after surgery. As far as we could ascertain, there have been no previous reports of 6-year survival with advanced colon cancer with metastases to the Virchow's and para-aortic lymph-nodes. Although the prognosis of patients with advanced cancer of the colon and metastasis to the para-aortic lymph-node has been reported to be poor, some patients may, nonetheless, show a good response to aggressive resection accompanied by D4 lymphadenectomy and followed by postoperative adjuvant chemotherapy.

Key words
advanced colon cancer, Virchow's lymph-node metastasis, a six-year survival case

Reprint requests
Hidefumi Baba Department of Surgery, Tachikawa Kyosai Hospital
4-2-22 Nishiki-cho, Tachikawa, Tokyo, 190-8531 JAPAN

Accepted
April 22, 1998

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