Two Cases of Anastomotic Recurrence after Functional End-to-End Anastomosis Performed for Colon Cancer

Hiroyuki Shirato, Toshiaki Watanabe, Toshiki Mimura, Tamuro Hayama, Hideki Yamada, Kyokun Haku, Keijiro Nozawa, Keiji Matsuda and Tadahiro Takada

Department of Surgery, Teikyo University School of Medicine

We report two cases of anastomotic recurrence after functional end-to-end anastomosis (FEEA) for colon cancer, which, most likely due to implantation of exfoliated cancer cells. Case 1: A 68-year-old man undergoing right hemicolectomy with FEEA for advanced cancer of the ascending colon 3 years and 4 months earlier was found in colonoscopy to have an ulcerated tumor at the anastomosis line. Biopsy specimens showed adenocarcinoma, necessitating partial resection of the bowel including the anastomotic recurrence. Case 2: A 70-year-old man undergoing right hemicolectomy with FEEA for advanced cancer of the transverse colon 2 years earlier was found in colonoscopy to have an ulcerated tumor at the anastomosis line, necessitating partial resection of the bowel including the anastomotic recurrence. In so far as we know, 14 cases of anastomotic recurrence after FEEA for colon cancer have been reported in the Japanese literature. Intraoperative rectal irrigation before stapled anastomosis is the established standard for low anterior resection of rectal cancer to minimize implantation metastasis at the anastomosis site. Our experience together with that reported in the literature underscores the need for intraluminal irrigation or bowel cleansing before FEEA. Simple, effective means for intraoperative bowel irrigation or cleansing and anastomosis procedures for FEEA must thus be developed to prevent anastomotic recurrence.

Key words
functional end-to-end anastomosis, anastomotic recurrence, implantation

Reprint requests
Hiroyuki Shirato Department of Surgery, Teikyo University School of Medicine
2-11-1 Kaga, Itabashi-ku, 173-8605 JAPAN

Accepted
March 28, 2007

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