A Case of Suture Line Recurrence in the Esophagojejunostomy and the Elevated Jejunal Stump after Total Gastrectomy for Gastric Cancer

Hayato Nakamura, Kazuhiro Hiramatsu, Takehito Katoh, Masaomi Suzuki, Yoshihisa Shibata, Motoi Yoshihara, Takashi Ikeyama and Kiyoshi Suzumura

Department of Surgery, Toyohashi Municipal Hospital

We report a case of suture-line gastric cancer recurrence in both esophagojejunostomy and the elevated jejunal stump, diagnosed 4 months after total gastrectomy for advanced gastric cancer. A 76-year-old woman underwent total gastrectomy and splenectomy with D2 lymph node dissection for type 3 gastric cancer of the upper gastric body and IIa type early gastric cancer of the lower gastric body, and hernioplasty for esophageal hiatal hernia in August 2005. Histological examination showed the upper lesion to be moderately differentiated tubular adenocarcinoma (pT2 (ss), ly1, v0) and the lower lesion to be well-differentiated tubular adenocarcinoma (pT1 (m), ly0, v0) without nodal involvement. The proximal surgical margin was negative for cancer. Four months later, she was seen for dysphagia and endoscopy showed an irregular elevated tumor of the esophagojejunostomy, suggesting gastric cancer recurrence. The recurrent tumor was resected using a left thoracoabdominal approach. Histological study confirmed that the tumor was suture-line gastric cancer recurrence. We concluded that recurrence was due to implantation, judging from the negative surgical margin and the absence serious lymphatic involvement in the previous specimen.

Key words
gastric cancer, suture-line recurrence, implantation

Reprint requests
Hayato Nakamura Department of Surgery, Fukuroi Municipal Hospital
2515-1 Kuno, Fukuroi, 437-0061 JAPAN

Accepted
April 28, 2010

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