A Case of Long Survivor of CA19-9 Producing Advanced Rectal Cancer

Tetsuya Kaneko, Keisuke Terabe, Koichi Itoh, Koichi Fujita

Department of Surgery, Shinshiro City Hospital

A 50-year-old woman was referred to our hospital for rectal cancer. Abdominal CT showed swelling of the para-aortic lymph nodes, suggesting possible metastasis. Preoperative laboratory findings indicated a slightly high level of CEA (3.9 ng/ml) and a very high level of CA19-9 (2090 ng/ml). An operation was performed on December 17, 1989. Operative findings confirmed severe para-aortic lymph node metastasis. Abdominoperitoneal resection was performed with extended lymph node dissection including the paraaortic lymph nodes from the level of the left renal vein to the aortic bifurcation. Pathological examination revealed that all dissected para-aortic lymph nodes were metastatic. DNA histogram of the rectal cancer showed an aneuploid DNA pattern. Continuous intravenous administration of 5-fluorouracil (500 mg/day) was performed for 30 days. After that, tegafur was administered perorally by a local doctor. CA19-9 was normalized after the operation. At six years and 1 month after the operation, the patient is well without any sign of recurrence. Long-term survival after rectal cancer surgery in a patient with a high level of CA19-9, metastatic para-aortic lymph nodes and DNA aneuploid pattern is considered rare.

Key words
carbohydrate antigen 19-9 producing rectal cancer, para-aortic lymph node metastasis, radical resection

Reprint requests
Tetsuya Kaneko Department of Surgery II, Faculty of Medicine, Nagoya University
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
May 17, 1995

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